Clozapine tablets

Clozapine (Clozaril) 400 500-800 25- and 100-mg tablets FazaCIo (orally disintegrating tablets) 25 and 1 00 mg... 

Difficulty swallowing tablets/capsules Risperidone or aripiprazole liquid, orally-disintegrating tablets (risperidone, olanzapine, clozapine) Long-acting risperidone... 

Recurrent suicidal behavior (except orally disintegrating tablets) - For reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for reexperiencing suicidal behavior, based on history and recent clinical state. Continue clozapine treatment to reduce the risk of suicidal behavior for at least 2 years. 

Reinitiation of treatment - Nhen restarting patients who have had even a brief interval off clozapine (ie, 2 days or more since the last dose) treatment should be reinitiated with one half of a 25 mg tablet (12.5 mg) once or twice/day. If tolerated, patients may be titrated back to a therapeutic dose more quickly than is recommended for initial treatment. Any patient who has previously experienced respiratory or cardiac arrest with initial dosing but was then able to be successfully titrated to a therapeutic dose should be retitrated with extreme caution after even 24 hours of discontinuation. 

Orally disintegrating tablets - Do not push the orally disintegrating tablet through the foil. Just prior to use, peel the foil from the blister and gently remove the orally disintegrating tablet. Immediately place the tablet in the mouth, allow it to disintegrate, and swallow with saliva. No water is needed to take clozapine. Destroy half tablets. 

Since clozapine may be the gold standard and the last resort in the treatment of refractory schizophrenia, the authors of a review aimed to discover whether a trial with clozapine is adequate (15). The results favored the approach of increasing the clozapine plasma concentration in treatment-refractory schizophrenic patients who do not respond to an initial low-to-medium dose. Some patients, especially young male smokers, will need dosages over 900 mg/day, and the addition of low-dose fluvoxamine while closely monitoring clozapine concentrations can help to reduce the large number of tablets required, since fluvoxamine increases the clozapine plasma concentration 2- to 3-fold, maximally 5-fold, and reduces N-desmethylclozapine concentrations the combination can lead to non-linear kinetics of clozapine. 

Since clozapine is expensive, it is interesting that generic clozapine (given as 25 and 100 mg tablets) behaves like Clozaril, the branded formulation bioequivalence has been observed in 30 patients with schizophrenia (228). 

A 41-year-old woman took 12.5 g of clozapine (125 tablets of 100 mg each) in a suicide attempt (241). She developed agitation, hallucinations, diminished distrust, and lethargy she was given physostigmine 2 mg and recovered completely within 1 week. 

NITRATES 1. ANALGESICS-nefopam 2. ANTIARRHYTHMICS -disopyramide, propafenone 3. ANTIDEPRESSANTS-TCAs 4. ANTI EMETICS-cydizine 5. ANTIHISTAMINES -chlorphenamine, cyproheptadine, hydroxyzine 6. ANTIMUSCARINICS -atropine, benzatropine, cydopentolate, dicydover-ine, flavoxate, homat-ropine, hyoscine, orphenadrine, oxybutynin, procyclidine, propantheline, tolterodine, trihexyphenidyl, tropicamide. 7. ANTI-PARKINSON S DRUGS-dopaminergics 8. ANTI-PSYCHOTICS - pheno-thiazines, clozapine, pimozide 9. MUSCLE RELAXANTS-baclofen 1. t risk of antimuscarinic side-effects when isosorbide dinitrate is co-administered with these drugs 2. 1 efficacy of sublingual nitrate tablets... 

ANTIPSYCHOTICS-PHENOTHIAZINE, CLOZAPINE, PIMOZIDE NITRATES 1. T risk of antimuscarinic side-effects when isosorbide dinitrate is co administered with these drugs. 2.1 efficacy of sublingual nitrate tablets 1. Additive effect both of these drugs cause antimuscarinic side-effects 2. Antimuscarinic effects i saliva production, which i dissolution of the tablet 1. Warn patient of these effects 2. Consider changing the formulation to a sublingual nitrate spray... 

Clozapine (Fig. 18.49), a dibenzodiazepine, is used as tablets (25 and 100 mg) and appears as the free base. Olanzapine (Fig. 18.49) appears in a number of formulations including film-coated tablets (2.5-20 mg) and orodispersible tablets (5-20 mg). It can also be used as a powder for reconstitution. Zotepine (Fig. 18.49) is available as free base sugar-coated tablets (25-100 mg). Quetiapine (Fig. 18.49), on the other hand, is prepared as the fiimarate salt and tablets range between 25 and 300 mg. 

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