Clozapine

Pdoc brought up this med today. It is for schizophrenia but can use it off label for depression with suicidal ideation. The problem is you can only get it for a week at a time from the pharmacy and have to have weekly blood tests. Has anyone ever used this drug?

Weekly blood tests? Wow, I don't think I'd like that drug.

its your body, your life, etc., but...personally...I decided against clozapine when a doctor brought it up. Everyone is different, but for me making some changes in my life and adding a low dose of Lamictal to ongoing treatment proved to be the way forward.

From what I know about clozapine, the main use is for treatment resistant schizophrenia. I forget the exact rules, but if a person doesn't adequately respond to a certain number of different drugs from both the newer, "atypical" antipsychotic group and the older, "conventional" antipsychotic groups, then clozapine is considered. The adverse effects can be severe. People have died due to clozapine treatment.

I hope you find something that works for you.

chlozopine is supposed to be some wonder drug, as my friend put it. It is very heavy duty, and can effect your white blood count hence the weekly blood tests.

Sorry to tell this story, but I nearly died when I was put on it. I ended up with tachycardia, as my heart reacted badly to it. I was on the heart ward on a drip for about four five days. If the dose had went higher god only knows what might have happened. Things is I had a virus at the time and after the heart ward the doctor goes "not wanting to muddy the waters but lets try chlozopine again." I was like no! It had to be the drug because now I am fine I said.

I think if it works, and your body can handle it, its very effective. My friend was offered it and outright said no, she won't even ever go near it. If you can get another anti-psychotic, like Seroquel I would try them first but I don't want to sway your choice, chlozpine has a high success rate but I thought it was last resort for schizophrenia too.

I've been on it just over a year (finally down to monthly labs!) and it has probably saved my life. It is highly effective for me. However the side effects are tough and you need to really be committed to it. The main side effects for me are extreme fatigue (I need 10-12 hours of sleep most nights and I fight to fall asleep so I devote a great deal of my life to sleep), heavy drooling in my sleep, mild incontinence in my sleep, and weight gain (20 lbs in first 6 months then it leveled off--but I'm on a med to help with metabolism).

I went on it as a last resort. I had tried every other AAP except Saphris (no insurance coverage) and Invega (allergy to risperidone so presumed allergy to it since it is a metabolite). Older APs aren't an option for me due to problems I've had with other meds. I wouldn't recommend going on it unless it is a last resort because of the side effects and the rare chance of white blood cell issues. The labs are a pain, especially the first 6 months while they are weekly, but that was manageable once it became routine.

If nothing else works for you clozapine is a great last resort drug. I don't know if it is supposed to be highly effective for suicidal ideation. I have not had much on it but everything improved on it so I would expect that. I would have done as my pdoc did and tried everything else possible before going on it (it makes it easier to deal with side effects when you know it's the last option).

On the more positive side if nothing works for you then yes, clozapine is a very, very effective drug and worth trying. When I say it saved my life I'm not exaggerating and it has controlled my bipolar far better than any other drug has done in 19 years of psych meds. I'm so thankful for this drug, even when the side effects are frustrating.

There are a few people on this site on it. The bipolar board is a good place to post since it seems like that is where several of us hang out.

Okay so here is the deal: Clozapine is a hectic drug. hectic.

It is usually reserved for treatment resistant schizophrenia, and in extremely rare cases, for resistant cases of bipolar disorder.

I personally would not opt for that one. Definitely not unless you are certain that other treatments are not possible (due to other medical reasons) or do not work.

Serious side effects such as such as neutropenia, agranulocytosis, seizures, myocarditis and cardiomyopathy are why monitoring is required.

I'm taking it for depression. It helps me sleep (big dose at night) and a low dose during the day helps me keep calmer.

I didn't really mind the weekly blood tests - the hospital is a few minutes' walk from my school so I'd go during a free period. I'm now on monthly blood tests.
Also sometimes I'd have to have blood tests twice a week because my levels were off.

I actually lost weight since I started, I think because I tapered off olanzapine.

It helps my ptsd and it helps me sleep, regretfully I'm still as depressed as when I started (I started January 2016)

Yeah I am thinking I won't be taking it. Sounds too scary.

It is a little scary. But if you need it, it's the best. It has the highest efficacy of any AP. I tried to be honest about some things I didn't know before I was on it; I hope I didn't scare you. The white blood count issues are very rare and after the first few months not likely at all. The US had a very hard time deciding to approve the med (works great but don't want sued type of thing) and so they make sure the blood is monitored. But it's unlikely as are cardiac side effects or much of anything but nuisance issues.

I would not take it if there is anything that you haven't tried yet but if you've tried everything it is much better than nothing. In some ways it has been easier for me than Seroquel was; my cholesterol is lower, my sleep is generally better although I do need a lot of it, my anxiety is better, etc.

So I guess I'm saying that I believe it should be used as a last resort, which is how it is approved and even the webpage for clozaril says it is a last resort drug. But if you need a last resort it is very worthwhile to try it.

I have been taking clozapine for bipolar for ten years and it works well for me. It has a fairly short half-life though so if I don't get my refill I tend to get hypomanic after missing two or three doses.

Currently the clozaril registry requires a CBC once a week for six months, every two weeks for six months and every month thereafter. Neutropenia is rare but dangerous but I have always had good labwork so for me the drug is a good choice.

I had to do weekly blood counts for 6 months and went straight to monthly afterwards.

Also, my pdoc said the blood side effects weren't necessarily worse than with other AAP's, just better documented.