Refractory schizophrenia and clozapine Flashcards Preview

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Flashcards in Refractory schizophrenia and clozapine Deck (18)
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1
Q

Starting dose

A

12.5mg nocte

2
Q

What should happen in the first six hours following the first dose of clozapine

A

Hourly BP monitoring, not necessary if first dose given nocte

3
Q

Day 2 dosing

A

12.5mg BD

4
Q

Titration after day 2

A

If tolerating, can increase by 25-50mg/day until 300mg/day

5
Q

Suggested starting regime for inpatients

A
Day 1: 12.5mg nocte
Day 2: 12.5 BD
Day 3/4: 25 BD
Day 5/6: 25, 50
Day 7: 50 BD
Day 8: 50, 75
Day 9: 75 BD
Day 10: 75, 100
Day 11: 100 BD
Day 12: 100, 125
Continue increasing by 25mg/day (increased dose at nocte)
6
Q

Target dose for female non-smokers

A

250mg/day

7
Q

Target dose male non-smokers

A

350mg/day

8
Q

Target dose female smokers

A

450mg/day

9
Q

Duration of initial titration

A

over ~3 weeks

10
Q

Further dose increases

A

50-100mg / week

11
Q

Target plasma level for adequate trial

A

350 ug/L

12
Q

when may slower titration be necessary

A

Elderly, physically compromised, young, previously poorly tolerated antipsychotics

13
Q

Evidence about clozapine augmentation and when should it be abandoned

A

little evidence to suggest anything more than a very small effect with augmentation using other antipsychotics
if attempted, should be done slowly, if no effect, abandon after 3-6 months

14
Q

augmentation with amisulpride

A

400-800 mg, may allow dose reduction

15
Q

augmentation with aripriprazole

A

15-30 mg may improve metabolic parameters

16
Q

augmentation with haloperidol

A

2-3 mg modest

17
Q

augmentation with lamotrigine

A

25-300mg partial non-responders, decrease alcohol consumption, moderate effect

18
Q

augmentation with omega 3

A

2-3g partial non-responders