Clozapine Pharmacology

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist

Education, Health & Fitness, Medicine

5 • 716 Ratings

🗓️ 23 May 2019

⏱️ 14 minutes

🔗️ Recording | iTunes | RSS

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Summary

On this episode, I discuss clozapine pharmacology. This drug has multiple mechanisms of action: Dopamine blockade, anticholinergic activity, and alpha blocking activity all contribute to the complexity of this drug.

Smoking cessation can significantly increase the concentrations of clozapine. This is because smoking can induce CYP1A2. Listen to the podcast for more details on how this can impact our patients clinically.

Clozapine has 5 boxed warnings. I discuss them all in this podcast. The most well-known boxed warning is for agranulocytosis.

Because clozapine has alpha blocking activity, it can cause orthostasis. We need to monitor for this.

Clozapine can cause QTc prolongation. Keep an eye out for other medications that the patient may be taking that can also cause this. Examples include: amiodarone, ondansetron, quinolones, and macrolides

Transcript

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0:00.0	Hey all, welcome back to the real-life pharmacology podcast. This is your host, Eric Christensen,
0:05.1	pharmacist. And today I'm going to cover clausapine. Now I know if you've been listening to the podcast
0:10.9	closely, I did cover antipsychotics in the past. But clausapine has so many unique clinical quirks and pearls that you absolutely must know.
0:24.7	I definitely wanted to take some time and specifically go through this medication on its own.
0:31.4	So Clauseapine, because of so many clinical quirks, pearls, warnings, this drug is not used very often and is used
0:41.3	pretty much exclusively by specialists, psychiatrists, and things of that nature. However,
0:48.4	its ramifications on the potential to cause problems and or interact with other medications is very, very important, which is why I was
0:59.3	going to cover it today. And I have seen significant problems come up with clausapine that you
1:06.6	definitely need to be aware of and need to monitor. It can definitely be a very powerful medication, very helpful medication in a patient with, you know, treatment resistant, treatment
1:17.1	refractory, schizophrenia, but we need to know some of those clinical quirks and pearls to monitor.
1:23.7	So mechanistically, I'm going to cover that quickly here, it is a dopamine antagonist as one of its primary mechanism of actions.
1:32.3	Also does have some serotonin 2A antagonist effects as well.
1:38.3	Alpha blockade, anhystamine blockade, and anticholinergic activity as well so important to remember those as far as
1:48.2	adverse effect profile goes so alpha blockade can cause some orthostasis antihistamine you know sedation
1:55.8	things of that nature anticholinergic effects dry dry mouth, and things of that nature as well.
2:03.2	So let's cover those boxed warnings.
2:06.6	I think it's really, really important that you remember this.
2:10.6	And as I was reviewing my information and basically re-educating myself, reminding myself of some important things about
2:20.7	clausapine, I was not aware that there were five boxed warnings. I definitely remembered some
2:27.2	of the adverse effects of the medications, but I didn't not realize that there were five
2:32.2	boxed warnings on this medication.
2:39.2	So number one, this is the one that comes up on pharmacology exams all the time,
	...

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