Review and Management of Clozapine Side Effects

Clozapine has demonstrated superior efficacy in relieving positive and negative symptoms intreatment-resistant schizophrenic patients; unlike other antipsychotics, it causes minimal extrapyramidalside effects (EPS) and has little effect on serum prolactin. Despite these benefits, the use ofclozapine has been limited because of infrequent but serious side effects, the most notable beingagranulocytosis. In recent years, however, mandatory blood monitoring has significantly reduced boththe incidence of agranulocytosis and its associated mortality. The occurrence of seizures appears to bedose-related and can generally be managed by reduction in clozapine dosage. Less serious and morecommon side effects of clozapine including sedation, hypersalivation, tachycardia, hypotension, hypertension,weight gain, constipation, urinary incontinence, and fever can often be managed medicallyand are generally tolerated by the patient. Appropriate management of clozapine side effects facilitatesa maximization of the benefits of clozapine treatment, and physicians and patients alikeshould be aware that there is a range of benefits to clozapine use that is wider than its risks.