Handouts · Medications
Clozapine
A uniquely effective antipsychotic for treatment-resistant schizophrenia. It works when others haven’t, but requires close blood monitoring for safety.
What It Is
Clozapine is the most effective medicine for schizophrenia that hasn’t responded to other treatments, and it can lower suicide risk.
It requires regular blood tests because it can rarely lower infection-fighting white cells. This monitoring keeps you safe.
How to Take It
Start low and increase slowly to limit dizziness and sedation. Take with or without food.
Never miss more than 2 days without telling us — if you do, the dose usually must be re-started low to stay safe. Do not stop suddenly.
Black Box Warnings (Several)
- Severe low white blood cells (neutropenia/agranulocytosis) — needs regular blood monitoring.
- Seizures — dose-related.
- Heart inflammation (myocarditis) and weakened heart muscle (cardiomyopathy).
- Slow heart rate / fainting from low blood pressure, especially when starting.
- Increased risk of death in older adults with dementia.
Common Side Effects
- Drowsiness and dizziness.
- Drooling, especially at night.
- Constipation — take this seriously; it can become dangerous.
- Weight gain, fast heartbeat.
Serious — Seek Care Now
- Fever, sore throat, mouth sores, or infection — may mean low white cells; get a blood test right away.
- Chest pain, shortness of breath, fast or pounding heart — possible heart inflammation, especially in the first weeks.
- No bowel movement for several days, severe belly pain or bloating — possible bowel blockage.
- Seizure, fainting.
Alcohol
Avoid alcohol — it adds to sedation and low blood pressure.
Required Monitoring
• Blood count (ANC) through the national REMS program: weekly for 6 months, then every 2 weeks for 6 months, then monthly
• Heart checks early on (EKG; troponin/CRP if symptoms) for myocarditis
• Weight, glucose, and lipids
• Bowel function — report constipation promptly