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This medication can cause a serious decrease of a certain type of white blood cellsneutropeniaTo make sure you have enough white blood cellsyour doctor will order lab tests before starting and while your are taking clozapineNeutropenia may lower your ability to fight infectionsGet medical help right away if you have any signs of severe neutropenia or infectionsuch as sore throat that doesn’t go awayfeverswollen lymph nodesunusual tirednessweakness
This medication may rarely cause a very serious condition called neuroleptic malignant syndromeNMSGet medical help right away if you have any of the following symptomsfevermuscle stiffness/pain/tenderness/weaknesssevere tirednesssevere confusionsweatingfast/irregular heartbeatdark urinesigns of kidney problemssuch as change in the amount of urine
Analysis of safety databases suggests that the use of Clozaril is associated with an increased risk of myocarditis especially duringbut not limited tothe first two months of treatmentSome cases of myocarditis have been fatalPericarditis/pericardial effusion and cardiomyopathy have also been reported in association with Clozaril usethese reports also include fatalitiesMyocarditis or cardiomyopathy should be suspected in patients who experience persistent tachycardia at restespecially in the first two months of treatmentand/or palpitationsarrhythmiaschest pain and other signs and symptoms of heart failuree.gunexplained fatiguedyspnoeatachypnoeaor symptoms that mimic myocardial infarctionOther symptoms which may be present in addition to the above include flu-like symptomsIf myocarditis or cardiomyopathy is suspectedClozaril treatment should be promptly stopped and the patient immediately referred to a cardiologist.
Cases have been reported of an interaction between citalopram and clozapinewhich may increase the risk of adverse events associated with clozapineThe nature of this interaction has not been fully elucidated.
An approximately 3-fold increased risk of cerebrovascular adverse events has been seen in randomised placebo controlled clinical trials in the dementia population with some atypical antipsychoticsThe mechanism for this increased risk is not knownAn increased risk cannot be excluded for other antipsychotics or other patient populationsClozapine should be used with caution in patients with risk factors for stroke.
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