Clozapine: Managing Side Effects

Clozapine: Managing Side Effects

By Dr. Harvinder Singh.

Physicians are aware of serious side effects from clozapine including agranulocytosis, myocarditis, cardiomyopathy, pulmonary embolism and seizure risk. This post is dedicated to management of less serious but more common side effects from clozapine.



(1) Orthostatic hypotension (alpha-adrenergic)

  • Prescribe dihydroergotamine.


(2) Sedation (histamine)

    • Dose at night time.


  • Avoid other sedating medications.


(3) Constipation (cholinergic)

  • Fiber, plenty of fluids, Laxatives
  • Important to ask this symptom during each visit due to risk of paralytic ileus with clozapine.


(4) Tachycardia (cholinergic)

    • Slow titration
    • Recommend EKG to rule out risk of myocarditis, cardiomyopathy.


  • Prescribe peripheral beta blocker


(5) Urinary incontinence (alpha-adrenergic)

  • Prescribe ephedrine, desmopressin


(6) Hypersalivation (cholinergic)

    • Place towel on pillow


    • Prescribe benztropine


    • Clonidine patch


    • Atropine eye drops sublingually (I use this one as first line with good response)


  • Ipratropium nasal spray sublingually


(7) Weight gain (histaminergic)

  • Nutritional counseling

Please do post your questions or comments below. 

Dr. Harvinder Singh, M.D. (Admin)

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