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Eeporge, your decision to use this drug is between you and your doctor and it might be a good idea to talk to others who are actually taking it. I can tell you
about my sons experience with Clozapine and what I know about this drug.

Clozapine (Clozaril) was the first atypical antipsychotic and is still considered today to be the best or "gold standard" even against the newer atypicals such as Olanzapine (Zyprexa), Quetiapine (Seroquel) etc. I'm very curious and excited about the newer drug Aripiprizol (Abilify) as there is talk that it may match Clozapine in it's benefical effects but without the side effects. Time will tell but from the anecdotal talk, people seem to be happy with it.

Clozapine and Olanzapine seem to have an effect of causing weight gain which is associated with diabetes. You need to be vigilant with a healthy diet and exercise to not gain the weight as it is easier to keep it off than to take it off after. According to one pharmacologist, weight gain plateaus after about 6mths.

Anytime I have questions about drugs I ask a trusted local pharmacist who is experienced with medications for mental illness and feel more secure with their information.

My son only experienced a moderate weight gain. He has a good psychiatric team with a psychiatrist who works with him and his side effects. He is on the most lowest and optimal dose for him (400mg/day). He experienced a great deal of sedation so his doctor has him take the majority of his dose at bedtime. He experienced hyper salivation when sleeping and used atropine drops in the first 6mths as well as towels on his pillow. The drops worked but were also very drying and he preferred to go without them and after 1 1/2 years on Clozapine he does not seem to have a big problem with this. Suck or chewing sugarless candy or gum to increases swallowing.

Clozapine is used for treament resistent patients mainly. Those who have severe positive and negative symptoms with no or little relief from the other drugs. It causes agranulocyotis in less than 1% of those taking it. Agranulocytosis is a dcreased number of white blood cells which then makes one suceptible to infections. Agranulocytosis is caused by many other commmon drugs including tylenol but it is very rare. The risk of suicide by those not being treated, in this population, is greater than the risk of death due to agranulocytosis. With blood monitoring the risk of agranulocytosis is 0.38%.

Clozapine does not extrapyrimidal symptoms (EPS) or tardive dyskinesia (TD) and has been shown to reduce TD in Parkinsons patients and those who developed it while taking older (typical) antipsychotics.

Clozapine's supperior effects may be due to activity at a broad range of receptors outside the dopamine (DA) system. Of particular interest is clozapine's high affinity for 5-HT receptors including 5-HT2, 5-HT3, 5-HT6 and 5-HT7 subtypes. Clozapine has high affinity for a1, a2 and muscarinic receptors, while it also has significant effect on GABA-ergic and glutamatergic mechanisms.

Here is a Cochrane Review on Clozapine where they have compared all of the studeis on Clozapine to date:

Clozapine versus typical neuroleptic medication for schizophrenia (Cochrane Review)
Wahlbeck K, Cheine M, Essali MA

Reviewers' conclusions: This systematic review confirms that clozapine is convincingly more effective than typical antipsychotic drugs in reducing symptoms of schizophrenia, producing clinically meaningful improvements and postponing relapse. Patients were more satisfied with clozapine treatment than with typical neuroleptic treatment. The clinical effect of clozapine, however, is at least in the short term not reflected in measures of global functioning such as ability to leave the hospital and maintain an occupation. The short-term benefits of clozapine have to be weighed against the risk of side effects. Within the context of trials, the potentially dangerous blood white cell decline seems to be more frequent in children and adolescents and in the elderly than in young adults or middle-aged people.The existing trials have largely neglected to assess the views of the patients and families on clozapine treatment. More community-based long-term randomised trials are needed to evaluate the efficacy of clozapine on global and social functioning in the community, as well as trials in special groups such as people with learning disabilities. The effects of clozapine in comparison to conventional neuroleptics in hospitalised adults is now well established and the conduct of further hospital-based short-term trials would be a waste of resources.

Citation: Wahlbeck K, Cheine M, Essali MA. Clozapine versus typical neuroleptic medication for schizophrenia (Cochrane Methodology Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.

[CENTER][B] References[/B]

[I]Focus on Clozapine
Miriam Naheed and Ben Green[/I]Dr Miriam Naheed, Specialist Registrar, Hollins Park Hospital, Warrington, Cheshire and Dr Ben Green, Senior Lecturer in
Psychiatry, Royal Liverpool University Hospital, L69 3GA.

First Published in Psychiatry On-Line as Version 1.0 10/5/2000

Clinical Psychopharmacology Seminar

[I]Tardive Dyskinesia[/I]Original Author: Bruce Alexander, Pharm.D, BCPP
Latest Revisers: Bruce Alexander, Pharm.D, BCPP, Brian C. Lund, Pharm.D.
Creation Date: 1996
Last Revision Date: October 1999

The University of Iowa-Virtual Hospital (a digital library of health information)

Breier, A., Tran, P., Harrea, J., Tollefson, G., & Bymaster,F.
[I]Current Issues in the Psychophramacology of Schizophrenia. Lippincott. [/I] Philadelphia. 2001

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