The mechanisms for this are unknown although it has been speculated that it may be related to hypersalivation, immune effects of clozapines effects on the resolution of inflammation. Overdose
Symptoms of overdose can be variable, but often include; sedation, confusion, tachycardia, seizures and ataxia. Fatalities have been reported due to clozapine overdose, though overdoses of greater than 5000 mg have been survived. Drug interactions
Fluvoxamine inhibits the metabolism of clozapine leading to significantly increased blood levels of clozapine.When carbamazepine is concurrently used with clozapine, it has been shown to decrease plasma levels of clozapine significantly thereby decreasing the beneficial effects of clozapine. Patients should be monitored for "decreased therapeutic effects of clozapine if carbamazepine" is started or increased. If carbamazepine is discontinued or the dose of carbamazepine is decreased, therapeutic effects of clozapine should be monitored. The study recommends carbamazepine to not be used concurrently with clozapine due to increased risk of agranulocytosis.Ciprofloxacin is an inhibitor of CYP1A2 and clozapine is a major CYP1A2 substrate. Randomized study reported elevation in clozapine concentration in subjects concurrently taking ciprofloxacin. Thus, the prescribing information for clozapine recommends "reducing the dose of clozapine by one-third of original dose" when ciprofloxacin and other CYP1A2 inhibitors are added to therapy, but once ciprofloxacin is removed from therapy, it is recommended to return clozapine to original dose.
In the television series Last Man On Earth (2015) the character Melissa has a psychotic episode and returns home and starts acting how she did pre-pandemic. Her boyfriend Todd sees her take a medication in the morning and asks her what it is. All she will say is "Santas Penis". Todd searches medication books and finds clozapine = Clause a peen. References
Further reading
External links
"Clozapine". Drug Information Portal. U.S. National Library of Medicine. "Clozapine Risk Evaluation and Mitigation Strategy (REMS) requirements will change on November 15, 2021". U.S. Food and Drug Administration (FDA). 29 July 2021. "Clozapine REMS Modification Frequently Asked Questions". U.S. Food and Drug Administration (FDA). 29 July 2021.