Clozaril schizophrenia

The first of the second-generation, or atypical, antipsychotics was clozapine. Clozapine (Clozaril) is relatively free of the movement disorders that characterize the first-generation drugs. This is true of, and defines, second-generation, atypical antipsychotics. It was a significant breakthrough for schizophrenia patients. 

Clozapine (Clozaril). Clozapine was introduced over 30 years ago but has only been available in the United States since 1990. It remains the medication of choice for treatment-resistant schizophrenia. Since its introduction, it has been used to treat acute mania with excellent results. Furthermore, it avoids the potential for tardive dyskinesia posed by haloperidol and the other typical antipsychotics. 

Winslow, R. (1990, May 14). Wonder drug Sandoz Corp. s Clozaril treats schizophrenia but can kill patients. The Wall Street Journal, p. 1. 

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). 

Although we include clozapine as a newer atypical antipsychotic medication, it does have a long history and in some texts may be listed as a traditional antipsychotic. Known by the brand name Clozaril, clozapine was originally synthesized in 1957 and in 1960 was one of the first antipsychotics released on the European market (Hippius, 1989). It was believed to be more successful than the typical antipsychotics because it did not seem to have the same negative side-effect profiles. Years later, eight documented cases of death were attributed to infections secondary to clozapine-induced agranulocytosis, and the product was withdrawn from unrestricted use (Davis Casper, 1977). Based on later studies that supported the success of clozapine with strict monitoring for treatment-resistant schizophrenia, the FDA approved it in 1990 (Barnes McEv-edy, 1996). 

Clozapine (Clozaril), a 5-HT2A/2c-receptor antagonist, represents a class of atypical antipsychotic drugs with reduced incidence of extrapyramidal side effects compared to the classical neuroleptics, and possibly a greater efficacy for reducing negative symptoms of schizophrenia. Clozapine also has a high affinity for subtypes of dopamine receptors. 

Ciozapine (Clozaril) Antipsychotic mechanism unclear. Blocks dopamine receptors as well as cholinergic, adrenergic, serotonergic histaminergic neurotransmission. Schizophrenia in those whom traditional antipsychotics have failed or have produced intolerable side effects. Very few extrapyramidal side effects. Potent antimuscarinic effects. Agranulocytosis in 2%. No tardive dyskinesia or increased prolactin release. 

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate ... 

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