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Myocarditis Schizophrenia and related psychoses CHAPTER 1 Clozapine: serious cardiovascular adverse effects Thromboembolism Over 30 years ago a possible association between clozapine and thromboembolism was first suggested.1,2 Later, data from Sweden3 suggeste...

Cardiomyopathy 254 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 4 days until a daily dose of 75mg is reached.22 Dose increases (of 6.25mg) can then be made every 3 days after this point, and every 2 days after reaching a daily dose of 150mg. Au...

References 256 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Paciullo CA. Evaluating the association between clozapine and venous thromboembolism. Am J Health Syst Pharm 2008; 65:1825–1829. Walker AM, et al. Mortality in current and ...

Clozapine-induced hypersalivation 258 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Clozapine-­induced hypersalivation Clozapine is well known to be causally associated with hypersalivation (sialorrhoea):1 excess salivary pooling in the mouth an...

References 260 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 References Man WH, et al. Reporting patterns of sialorrhea comparing users of clozapine to users of other antipsychotics: a disproportionality analysis using VigiBase. J Clin Psychoph...

Clozapine-induced gastrointestinal hypomotility Schizophrenia and related psychoses CHAPTER 1 Clozapine-­induced gastrointestinal hypomotility Constipation is a common adverse effect of clozapine treatment with a prevalence of more than 30%, three times that s...

Prevention and simple management of CIGH

Management of suspected acute CIGH 264 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Prevention and simple management of CIGH A slow clozapine titration may reduce the risk of developing constipation, with dose increments not exceeding 25mg/day ...

Clozapine rechallenge following severe constipation

Summary 24 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Given the association between combined antipsychotic medication and a greater adverse-­effect burden,15,44 it follows that it should be standard practice to document in the clinical record...

Key message

References Schizophrenia and related psychoses CHAPTER 1 Clozapine rechallenge following severe constipation Some patients have been successfully rechallenged following severe cases of CIGH, but this process does not come without risk. Prophylactic measures sh...

Clozapine, neutropenia and lithium

Mild neutropenia

Severe neutropenia or agranulocytosis Schizophrenia and related psychoses CHAPTER 1 Clozapine, neutropenia and lithium Mild neutropenia Around 3.8% of patients treated with clozapine develop neutropenia.1 Most of these cases are unrelated to clozapine treatmen...

Benign ethnic neutropenia 268 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Risk factors for agranulocytosis include increasing age and Asian race.5 Unlike neutropenia, risk of agranulocytosis appears to be higher in people of European ancestry ...

Concurrent medications

Management options