URDANETA CITY UNIVERSITY

COLLEGE OF NURSING

DRUG DOSAGE INDICATION THERAPEUTIC CONTRAINDICTION ADVERSE EFFECT NURSING CONSIDERATION

ACTION
Generic Adults Clozapine has History of bone marrow  Drowsiness, dizziness, CLINICAL ALERT!
Name : relatively weak disorders including headache; nausea,
 Initial therapy:  Management of  Name confusion has occurred
clozapine dopamine receptor- agranulocytosis, vomiting, constipation;
12.5 mg PO once severely ill between Colazal (balsalazide);
blocking activity at circulatory collapse, anxiety, confusion,
or twice daily. If schizophrenics dangerous effects could occur.
D1, D2, D3 and D5 alcoholic or toxic fatigue, transient fever.
using orally who are Use caution.
Brand Name: receptors but has psychosis, drug Rarely, dysphagia,
disintegrating unresponsive to
Clozaril, high affinity for the intoxication, acute pancreatitis,
Assessment
tablets, begin standard
FazaClo, Gen- D4 receptor. It has uncontrolled epilepsy, cholestatic jaundice;
with 1/2 (12.5 antipsychotic
Clozapine also blocking effects severe renal, hepatic or orthostatic hypotension,  History: Allergy to clozapine,
mg) of a 25-mg drugs
(CAN) on serotonin, α- cardiac disease; tachycardia; seizures; myeloproliferative disorders,
tablet and destroy  Reduction of the
adrenergic histamine paralytic ileus. hypersalivation. history of clozapine-induced
the remaining risk of recurrent
Classification: H1 and cholinergic Pregnancy and lactation.  Potentially Fatal: agranulocytosis or severe
half. Continue to suicidal behavior
Antipsychotic, receptors Rarely, granulocytopenia, severe CNS
25 mg PO daily in patients with
Dopaminergic thromboembolism. depression, comatose states,
or bid; then schizophrenia or
blocker Reversible neutropenia history of seizure disorders, CV
gradually schizoaffective
which may progress to disease, narrow-angle glaucoma,
increase with disorder (not
Pregnancy a potentially fatal lactation, pregnancy
daily increments orally
Category B
of 25–50 mg/day,
 URDANETA CITY UNIVERSITY
COLLEGE OF NURSING

if tolerated, to a disintegrating agranulocytosis. Fatal  Physical: T, weight; reflexes,

dose of 300–450 tablet) myocarditis. orientation, IOP, ophthalmologic
mg/day by the examination; P, BP, orthostatic
end of second BP, ECG; R, adventitious sounds;
week. Adjust bowel sounds, normal output,
later dosage no liver evaluation; prostate
more often than palpation, normal urine output;
twice weekly in CBC, urinalysis, LFTs, renal
increments < 100 function tests, EEG
mg. Do not
Interventions
exceed 900
mg/day.
 BLACK BOX WARNING: Use
 Maintenance:
only when unresponsive to
Maintain at the
conventional antipsychotic drugs;
lowest effective
risk of serious CV and respiratory
dose for
effects.
remission of
 Obtain clozapine through the
symptoms.
Clozaril Patient Assistance
 Discontinuation
Program. For more information,
of therapy:
call 1-800-448-5938.
Gradual
reduction over a
 URDANETA CITY UNIVERSITY
COLLEGE OF NURSING

2-wk period is  Dispense only 1 wk supply at a

preferred. If time.
abrupt  Monitor WBC carefully prior to
discontinuation is first dose.
required,  BLACK BOX WARNING:
carefully monitor Weekly monitoring of WBC
patient for signs during treatment and for 4 wk
of acute thereafter. Dosage may be
psychotic adjusted based on WBC count.
symptoms. Potentially fatal agranulocytosis
 Reinitiation of has been reported.
treatment:  Monitor T. If fever occurs, rule
Follow initial out underlying infection, and
dosage consult physician for comfort
guidelines, use measures.
extreme care;  BLACK BOX WARNING:
increased risk of Monitor for seizures; with history
severe adverse of seizures, risk increases as dose
effects with re- increases.
exposure.  Monitor elderly patients for
dehydration. Institute remedial
Pediatric Patients
measures promptly; sedation and
 URDANETA CITY UNIVERSITY
COLLEGE OF NURSING

decreased thirst related to CNS

 Safety and
effects can lead to dehydration.
efficacy in
 Monitor patient regularly for signs
patients < 16 yr
and symptoms of diabetes
not established.
mellitus.
 Encourage voiding before taking
drug to decrease anticholinergic
effects of urinary retention.
 Follow guidelines for
discontinuation or reinstitution of
the drug.
 Educate patient on seriousness of
potential agranulocytosis.

Teaching points

 Weekly blood tests will be taken

to determine safe dosage; dosage
will be increased gradually to
achieve most effective dose. Only
1 week of medication can be
dispensed at a time and will
URDANETA CITY UNIVERSITY
COLLEGE OF NURSING

depend on your white blood cell

count. Do not take more than your
prescribed dosage. Do not make
up missed doses, instead contact
your health care provider. Do not
stop taking this drug suddenly;
gradual reduction of dosage is
needed to prevent side effects.
 If you think you are pregnant or
wish to become pregnant, contact
your health care provider.
 You may experience these side
effects: Drowsiness, dizziness,
sedation, seizures (avoid driving
or performing tasks that require
concentration); dizziness,
faintness on arising (change
positions slowly); increased
salivation (reversible);
constipation (consult your health
care provider for correctives); fast
heart rate (rest, take your time).
 URDANETA CITY UNIVERSITY
COLLEGE OF NURSING

 Report lethargy, weakness, fever,

sore throat, malaise, mouth ulcers,
and flulike symptoms.

Name: Alexandra T. Manzano

Prepared by Submitted to
_____________________________________________ __________________________________________________
Name of Student Name of Clinical Instructor
(Signature over printed name) (Signature over printed name)
Year Level___________ Date_____________