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Clozapine is a medication used when other treatments have failed or cannot be tolerated, but it carries the risk of serious, possibly life-threatening side effects. Below are important safety warnings and instructions you should be aware of when taking clozapine:

• Neutropenia and Infection Risk: Clozapine can significantly reduce white blood cells (neutrophils), increasing infection risk. It is available under a controlled REMS Program in the U.S., requiring regular blood tests to monitor neutrophil levels. If you experience symptoms like fever, sore throat, or unusual tiredness, contact your healthcare provider immediately.

• Low Blood Pressure and Fainting: The medication may cause low blood pressure and slow heartbeat, leading to dizziness or fainting, especially when starting treatment or increasing dosage. If you are dehydrated or taking blood pressure medications, your risk increases. Rise slowly from sitting or lying positions to minimize dizziness, and stay hydrated.

• Seizures: There's an increased risk of seizures, particularly at higher doses or if you have a history of seizures. Inform family and caregivers of this risk and avoid activities like driving or swimming until you know how clozapine affects you.

• Heart Issues: Clozapine can cause myocarditis, pericarditis, or heart failure. Seek immediate medical help if you experience chest pain, irregular heartbeats, or shortness of breath. Discuss any history of heart problems with your provider.

• Dementia-Related Psychosis: Older adults with dementia-related psychosis face a higher mortality risk when taking clozapine, which is not approved for this use. Discuss alternative treatments with your provider if applicable.

• Metabolic Changes: The medication can increase blood sugar and cholesterol levels, leading to weight gain. Regular blood tests will monitor these changes. Maintain a healthy diet and exercise regularly.

• Severe Constipation: Clozapine can slow gut movement, causing severe constipation. Ensure adequate fluid intake and a fiber-rich diet. Contact your provider if you experience significant changes in bowel habits.

• Allergic Reactions and Inflammation: Rare allergic reactions or organ inflammation may occur. Report symptoms like rash, fever, or swollen lymph nodes to your provider promptly.

• QT Prolongation: Risk of life-threatening heart rhythm abnormalities exists, especially with certain pre-existing conditions or medications. Monitor heart health with your provider.

• Neuroleptic Malignant Syndrome: This rare, life-threatening condition requires immediate medical attention if symptoms such as high fever and confusion occur.

• Driving Impairment: Clozapine can impair concentration and reaction times. Avoid driving or operating machinery until you understand how it affects you.

• Liver Problems: Rare severe liver issues may arise, warranting regular liver function tests. Report symptoms like yellowing skin or severe abdominal pain immediately.

• Movement Disorders: Long-term use at high doses can cause involuntary movements. Discuss any symptoms with your provider.

• Phenylketonuria Advisory: Inform your provider if you have phenylketonuria, as dissolvable tablets contain phenylalanine.

Always consult your healthcare provider with any questions or concerns regarding clozapine treatment.

While taking this medication, you might experience some common side effects such as drooling, drowsiness, dizziness, constipation, headaches, and weight gain. These effects are generally mild and often diminish as your body adjusts to the medication. To combat constipation, consider a diet rich in fiber, stay hydrated, and maintain regular physical activity. In some cases, a laxative may be necessary, so consult a pharmacist for advice.

Occasionally, this medication can affect blood sugar levels, potentially leading to diabetes or worsening existing diabetes. If you notice increased thirst or urination, it’s important to monitor your blood sugar and discuss any changes with your healthcare provider. The drug might also cause significant weight gain and elevated cholesterol levels, which can contribute to heart disease risk.

Serious side effects, though rare, require prompt medical attention. These include seizures, uncontrollable muscle movements, severe dizziness, fainting, or breathing difficulties. In particular, watch for signs of neuroleptic malignant syndrome, such as high fever, muscle stiffness, and confusion. An allergic reaction, characterized by rash, swelling, or difficulty breathing, is also serious and warrants immediate care.

Be aware of symptoms indicating serious heart issues, liver problems, or pulmonary embolism, such as chest pain, yellowing of the skin, or sudden weakness. If you experience any severe side effects or symptoms not listed here, seek medical advice promptly. It's crucial to stay informed and vigilant about these potential reactions to ensure your safety while using this medication.

When taking clozapine, it's important to be aware of potential interactions with other medications or substances. Metoclopramide is one such drug that can interact with clozapine. Additionally, certain medications might influence how clozapine is processed in your body, potentially altering its effectiveness. These include Fluvoxamine, St. John's wort, and seizure medications like Carbamazepine and Phenytoin.

Inform your healthcare provider if you are using products that may cause drowsiness, such as opioid painkillers (e.g., codeine, hydrocodone), alcohol, cannabis, sleep aids, anxiety medications (e.g., Alprazolam, Lorazepam, Zolpidem), muscle relaxants (e.g., Carisoprodol, Cyclobenzaprine), or antihistamines (e.g., Cetirizine, diphenhydramine). Be cautious with over-the-counter products for allergies or colds, as they might contain ingredients that induce drowsiness.

Cigarette smoking can also reduce the blood levels of clozapine, so it's important to inform your doctor if you smoke or have recently quit.

There are medications that are generally not recommended to be used with clozapine due to possible adverse interactions. If these medications must be used together, your doctor may adjust dosages or how often you take them. Notable drugs in this category include bepridil, bromopride, cisapride, dronedarone, Fluconazole, Ketoconazole, and others. Always consult your healthcare provider about all the medications and supplements you are taking to ensure safe use of clozapine.