Clozaril

See full labeling. Risk of severe neutropenia; obtain CBC and confirm baseline ANC ≥1500/μL (≥1000/μL if benign ethnic neutropenia) prior to initiation. Monitor ANC weekly for 1^st 6 months; if acceptable ANC maintained, may reduce monitoring to every 2 weeks from 6–12 months, then monthly after 12 months. Cardio- or cerebrovascular disease. Conditions that would predispose to hypotension (eg, concomitant antihypertensives, dehydration, hypovolemia). Perform fall risk assessments when initiating and recurrently on long-term therapy. Reevaluate periodically. History of seizures or head trauma. Monitor for myocarditis and cardiomyopathy esp. during the first 2 months of therapy; discontinue and evaluate if suspected. Increased mortality in elderly with dementia-related psychosis (not approved use). Increased risk of QT prolongation; discontinue if interval >500msec. Significant cardiac arrhythmia. Recent MI. Uncompensated heart failure. Consider obtaining baseline ECG and serum chemistry panel. Correct electrolyte abnormalities prior to starting; obtain baseline serum potassium and magnesium levels; monitor periodically thereafter. Monitor for hepatotoxicity; consider permanently discontinuing if clozapine-associated hepatitis or elevated transaminases occur. Monitor for hyperglycemia, diabetes or risk factors thereof, dyslipidemia, weight, cholinergic rebound. Glaucoma. Constipation (screen and treat prior to initiation). GI hypomotility with severe complications. Urinary retention. Significant prostatic hypertrophy. Exclude severe neutropenia, infection, or neuroleptic malignant syndrome if fever occurs. Pulmonary disease. Renal or hepatic impairment, CYP2D6 poor metabolizers: may need to reduce dose. Elderly or hospice patients. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3^rd trimester of pregnancy). Pregnancy (Cat.B). Nursing mothers: not recommended.