Reasons for Clozapine Discontinuation and No Rechallange

Reasons for Clozapine Discontinuation and No Rechallange

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CARDIAC SIDE EFFECTS

  1. QTc > 500 msec —> Discontinue Clozapine.
  2. Myocarditis (Increased Heart Rate, ST elevation, Troponins >2 times normal) —> Discontinue Clozapine and Rechallenge not recommended.
  3. Cardiomyopathy (confirm with ECHO) —> Discontinue Clozapine and Rechallenge not recommended
  4. Atrial Fibrillation —> Discontinue Clozapine.
  5. Orthostatic Hypotension —> Dose reduction or Slow up titration —> Drink fluids + salt containing diets —> if still persists —> compression stocking + fludrocortisone. 

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HEMATOLOGIC SIDE EFFECTS

  1. Eosinophilia —> Exclude myocarditis, agranulocytosis, toxic hepatitis.
  2. Thrombocytopenia < 50,000/uL —> Discontinue Clozapine.
  3. Thrombocytosis  >750,000 —> Discontinue Clozapine.
  4. Neutropenia and Agranulocytosis —> see REMS updated guidelines for more details. 

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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