Clozaril Consumer Medicine Information

25mg and 100mg tablets
Clozapine

What is in this leaflet

This leaflet answers some common questions about Clozaril.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Clozaril against the benefits they expect it will provide.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Clozaril is used for

Clozaril belongs to a group of medicines called antipsychotics. It helps to correct chemical imbalances in the brain which may cause mental illness.

Clozaril is used to treat schizophrenia, which is a mental illness with disturbances in thinking, feelings and behaviour.

Clozaril is only used in patients with schizophrenia when other antipsychotic medicines either have not worked or have caused severe side effects.

Ask your doctor if you have any questions about why Clozaril has been prescribed for you.
Your doctor may have prescribed it for another reason.

Clozaril is available only with a doctor's prescription. There is no evidence that it is addictive.

Clozaril is not recommended for use in children under the age of 16, as there is not enough information on its use in that age group.

Before you take Clozaril

When you must not take it

Do not take Clozaril if you have an allergy to clozapine, the active ingredient, or to any of the other ingredients of Clozaril listed at the end of this leaflet.
Some of the symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin.

Do not take Clozaril if you have a low white blood cell count or have previously had a low white blood cell count caused by a medicine.
Clozaril can cause agranulocytosis. This is a condition where the number of white blood cells are reduced. These cells are needed to fight infections. If you have a low white blood cell count or have had one in the past, you must not take Clozaril.

Do not take Clozaril if you have any of the following medical conditions:

  • any disease of the blood which causes a reduced number of red blood cells or platelets
  • symptoms of active liver disease such as jaundice (yellow colour to the skin and eyes, feeling sick, loss of appetite) or any other severe liver disease
  • severe kidney disease
  • myocarditis (an inflammation of the heart muscle) or any other severe heart disease
  • epilepsy that is not controlled (i.e. you still have some seizures)
  • paralytic ileus, a condition in which the small bowel does not work properly

Clozaril must not be given to anyone who is unconscious or in a coma, or who has an acute mental illness caused by alcohol or drugs.

Do not take Clozaril after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering.
In that case, return it to your pharmacist.

If you are not sure whether you should start taking Clozaril, talk to your doctor or pharmacist.

Before you start to take it

Tell your doctor if you have ever had any of the following medical conditions:

  • any form of heart disease or a family history of heart disease
  • neuroleptic malignant syndrome, a reaction to some medicines with a sudden increase in body temperature, sweating, fast heart beat, muscle stiffness and fluctuating blood pressure, which may lead to coma
  • tardive dyskinesia, a reaction to some medicines with uncontrolled movements of the tongue, face, mouth or jaw (such as puffing of the cheeks, puckering of the mouth or chewing movements).
  • problems with your liver or kidneys
  • glaucoma, a condition in which there is usually a build-up of fluid in the eye
  • prostate problems
  • epilepsy that is under control (i.e. you no longer have seizures)
  • diabetes
  • chronic constipation

Tell your doctor if you are pregnant or intend to become pregnant.
Experience with Clozaril in pregnancy is very limited. If you need to take this medicine during pregnancy, your doctor will discuss with you the benefits and risks of taking it.

Tell your doctor if you are breast-feeding or plan to breast-feed.
Breast-feeding is not recommended while you are taking Clozaril. This medicine may pass into breast milk and there is a possibility that your baby may be affected.

Tell your doctor if you smoke and how much coffee you drink.
Sudden changes in your usual smoking or coffee drinking habits can also change the effects of Clozaril.

Tell your doctor if you will be in a hot environment or you do a lot of vigorous exercise.
Clozaril may make you sweat less, causing your body to overheat.

Tell your doctor if you are lactose intolerant.
This medicine contains lactose.

Tell your doctor if you have allergies to other medicines or to any other substances such as foods, preservatives or dyes.

If you have not told your doctor about any of the above, tell him/her before you start taking Clozaril.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines and Clozaril may interfere with each other. These include:

  • medicines that decrease the number of blood cells produced by your body
  • other antipsychotic medicines used to treat mental illnesses
  • medicines used to control depression or mood swings
  • benzodiazepines and other medicines used to treat anxiety or to help you sleep
  • medicines used to control epilepsy, including phenytoin, carbamazepine and valproic acid
  • warfarin, a medicine used to prevent blood clots
  • strong pain killers such as morphine
  • St John's wort, (hypericum) an ingredient in many medicines that you can buy without a prescription from a pharmacy, health food shop or supermarket
  • antihistamines, medicines used for colds or allergies such as hay fever
  • anticholinergic medicines, which are used to relieve stomach cramps, spasms and travel sickness
  • medicines used to treat Parkinson's disease
  • medicines used to treat high blood pressure
  • medicines used to treat a fast or irregular heart beat
  • some medicines used to treat stomach ulcers, including cimetidine and omeprazole
  • some antibiotic medicines, including erythromycin and rifampicin
  • some medicines used to treat fungal or viral infections
  • nicotine in medicines used to help you quit smoking, such as nicotine patches or chewing gum
  • atropine, a medicine which may be used in some eye drops or cough and cold preparations
  • adrenaline, a drug used in emergency situations

These medicines may be affected by Clozaril or they may affect how well Clozaril works. You may need to take different amounts of your medicines or you may need to take different medicines.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking Clozaril.

How to take Clozaril

Follow all directions given to you by your doctor and pharmacist carefully.
They may differ from the information contained in this leaflet.

If you do not understand the instructions on the label, ask your doctor or pharmacist for help.

How much to take

The usual starting dose is half of a 25 mg tablet once or twice on the first day. The dose is usually increased to one 25 mg tablet once or twice on the second day. After that the dose can be slowly increased until the desired effect is achieved. Usually the total amount of Clozaril needed each day will be between 200 mg and 450 mg but some people will need higher doses.

Once the maximum benefit is reached, the dose can often be decreased to between 150 mg and 300 mg each day.

If you have heart, kidney or liver disease, are prone to seizures (fits) or are elderly, your doctor may start you on a lower dose and increase it more gradually to prevent unwanted side effects.

How to take it

Swallow the tablets with a full glass of water or other liquid. Take the tablets at about the same time each day.
Taking your tablets at the same time each day will have the best effect. It will also help you remember when to take them.

The total daily amount of Clozaril is usually divided into 2 doses. But, if your total dose is 200 mg or less, your doctor may allow you to take the whole amount at once, usually in the evening.

If you forget to take it

If it is almost time for your next dose (within 4 hours), skip the dose you missed and take the next dose when you are meant to.

Otherwise, take it as soon as you remember, and then go back to taking it as you would normally.

Do not take a double dose to make up for the one that you missed.
This may increase the chance of you getting an unwanted side effect.

If you have forgotten to take Clozaril for more than 2 days, do not start taking it again before you contact your doctor.
To prevent unwanted side effects, your doctor will probably want you to restart Clozaril at a low dose and increase it gradually back to the amount you were taking before.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

How long to take it

Continue taking the tablets for as long as your doctor tells you.
Your doctor will check your progress to make sure the medicine is working and will discuss with you how long your treatment should continue.

If you take too much (Overdose)

Immediately telephone your doctor or the Poisons and Hazardous Chemicals National Information Centre, Dunedin (telephone 0800 POISON or 0800 764 766), or go to the Accident and Emergency at your nearest hospital if you think that you or anyone else may have taken too much Clozaril. Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.

The most common symptoms of an overdose include light headedness due to low blood pressure, too much saliva, difficulty breathing, fast or irregular heartbeat, drowsiness, confusion and unconsciousness.

While you are taking Clozaril

Things you must do

  1. Have regular blood tests

    You must have strict and regular blood tests while taking Clozaril.

    Clozaril can cause agranulocytosis. This is a condition where the number of white blood cells in your body is reduced. White blood cells are needed to fight infection.

    There is no way of knowing who is at risk of developing agranulocytosis.
    Deaths have occurred in severe cases of agranulocytosis. However, with regular blood tests, the problem can be detected early. If Clozaril is stopped as soon as possible, the white blood cell numbers should return to normal.

    You must have a blood test at least once a week for the first 18 weeks after starting Clozaril.
    This is the time when the risk of agranulocytosis is greatest. These tests can tell the doctor whether the white blood cell count is dropping.

    After 18 weeks, you must have a blood test at least every 4 weeks for as long as you are taking Clozaril and for a month after stopping the medicine.
    There are some situations where you may need to have blood tests more often (eg. twice a week). Your doctor will explain this to you.

    If the number of white blood cells falls below a critical level, Clozaril will be stopped immediately and you must never take Clozaril again.
  2. Watch for important side effects

    If you develop a fast or irregular heartbeat that is present even when you are resting, accompanied by rapid breathing, shortness of breath, dizziness or light headedness, or chest pain, contact your doctor immediately.

    These symptoms could be signs of myocarditis, an inflammation of the heart muscle, or another heart condition. Your doctor may want to refer you to a cardiologist for further tests.

    If you develop a fever, contact your doctor immediately.
    Some patients develop a fever in the first few weeks of taking Clozaril. You must be checked carefully to make sure that you do not have agranulocytosis, myocarditis or neuroleptic malignant syndrome, a reaction to some medicines with a sudden increase in body temperature.

    If you develop a sore throat, mouth ulcers, flu-like symptoms or any other sign of infection, contact your doctor immediately.
    Your doctor will check your blood to decide if your symptoms are an early sign of agranulocytosis. Flu-like symptoms may also be a sign of myocarditis.

    If you notice any uncontrolled movements of the tongue, face, mouth or jaw, such as puffing of the cheeks, puckering of the mouth or chewing movements, tell your doctor immediately.
    These are symptoms of a very rare condition called tardive dyskinesia which may develop in people taking antipsychotic medicines. This condition is more likely to happen during long-term treatment, especially in elderly women. In very rare cases, it may be permanent. However, if detected early, these symptoms are usually reversible.
  3. Other Precautions

    Make sure you use a contraceptive to prevent pregnancy during treatment with Clozaril. If you become pregnant while taking this medicine, tell your doctor immediately.

    Your doctor can discuss with you the risks of taking it while you are pregnant.

    If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking Clozaril.

    If you plan to have surgery, tell your doctor that you are taking Clozaril.

    Tell any other doctor, dentist or pharmacist who treats you that you are taking Clozaril.

Things you must not do

Do not stop taking Clozaril or lower the dosage, even if you are feeling better, without checking with your doctor.
If you stop taking Clozaril suddenly, your condition may worsen or you may have unwanted side effects such as headache, nausea (feeling sick), vomiting and diarrhoea. If possible, your doctor will gradually reduce the amount you take each day before stopping the medicine completely.

Do not take Clozaril to treat any other complaints unless your doctor tells you to.

Do not give this medicine to anyone else, even if their condition seems similar to yours.

Things to be careful of

Be careful driving or operating machinery until you know how Clozaril affects you.
As with other antipsychotic medicines, Clozaril may cause tiredness, drowsiness, dizziness, fainting or seizures (fits) in some people, especially at the start of treatment. Make sure you know how you react to Clozaril before you drive a car, operate machinery or do anything else that could be dangerous.

Be careful when drinking alcohol or taking pain relievers, sleeping tablets or antihistamines (medicines for colds or allergies such as hay fever) while you are taking Clozaril.
Clozaril can increase the drowsiness caused by alcohol and by medicines that affect your nervous system.

If Clozaril makes you feel light-headed, dizzy or faint, be careful when getting up from a sitting or lying position.
Clozaril may lower your blood pressure, especially at the start of treatment. These symptoms can usually be prevented by getting up slowly and flexing leg muscles and toes to get the blood flowing. When getting out of bed, dangle your legs over the side for a minute or two before standing up.

Make sure you keep cool in hot weather and keep warm in cool weather.
As with other antipsychotic medicines, Clozaril may affect the way your body reacts to temperature changes. It may prevent sweating, even during heatwaves. You may feel dizzy or faint if you are too hot.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Clozaril, even if you do not think it is connected with the medicine.
All medicines can have side effects. Sometimes they are serious, but most of the time they are not. You may need medical treatment if you get some of the side effects. Some of the side effects of Clozaril can be relieved by changing the dose.

If you are over 65 years old, you should be especially careful while taking this medicine. Report any side effects promptly to your doctor.
You may be more likely to get some of the side effects of Clozaril, such as rapid heart beat, dizziness or light- headedness due to low blood pressure, constipation and difficulty urinating.

Do not be alarmed by this list of possible side effects. You may not experience any of them. Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

  • tiredness, drowsiness
  • dizziness or light headedness when standing up
  • constipation (if it seems to be getting worse, check with your doctor immediately)
  • headache
  • agitation, confusion, vivid dreams
  • dry mouth
  • blurred vision
  • increased or decreased sweating
  • too much saliva
  • nausea (feeling sick), vomiting
  • difficulty in swallowing
  • weight gain

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:

  • fever, sore throat, mouth ulcers, "flu-like" symptoms (chills, aching joints, swollen glands, lack of energy) or any other signs of infection
  • a fast or irregular heartbeat that is present even when you are resting, accompanied by rapid breathing, shortness of breath, dizziness or light headedness, or chest pain
  • sudden signs of allergy such as rash, itching or hives on the skin; swelling of the face, lips, tongue or other parts of the body; wheezing or troubled breathing
  • symptoms of neuroleptic malignant syndrome, with a sudden increase in body temperature, sweating, fast heart beat, muscle stiffness and fluctuating blood pressure, which may lead to coma
  • seizures (fits)
  • pain in the stomach, often accompanied by nausea and vomiting
  • severe constipation, which may be accompanied by abdominal pain and bloating
  • signs of loss of blood sugar control such as excessive thirst, drinking or eating large amounts, weakness, passing large amounts of urine, dry mouth and skin
  • bleeding or bruising more easily than normal
  • signs that blood clots may have formed, such as sudden severe headache, sudden loss of coordination, blurred vision or sudden loss of vision, slurred speech, numbness in an arm or leg
  • yellowing of the skin and/or eyes, sometimes accompanied by feeling sick and loss of appetite
  • difficulty in passing urine (water) or blood in the urine; loss of bladder control
  • rigidity or stiffness in the arms and legs, shaking or tremor, feeling unable to sit still
  • symptoms of tardive dyskinesia (uncontrolled movements of the tongue, face, mouth or jaw such as puffing of the cheeks, puckering of the mouth or chewing movements).
  • persistent painful erection

The above are serious side effects that need medical attention.

Tell your doctor if you notice anything else that is making you feel unwell.
Other side effects not listed here may happen in some people.

After using Clozaril

Storage

  • Keep your tablets in the original container until it is time to take them.
  • Store the tablets in a cool dry place.
  • Do not store Clozaril or any other medicine in the bathroom or near a sink.
  • Do not leave it in the car or on window sills.

Heat and dampness can destroy some medicines. Clozaril will keep well if it is cool and dry.

Keep the medicine where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking Clozaril or it has passed its expiry date, ask your pharmacist what to do with any medicine you have left over.

Remember that you must still have your blood tested for a month after stopping this medicine.

Product description

What it looks like

Clozaril 25 mg: small, round, yellow tablets with a break line and LO on one side and SANDOZ on the other side; containers of 50 tablets.

Clozaril 100 mg: small, round, yellow tablets with a break line and ZA on one side and SANDOZ on the other side; containers of 50 tablets.

The quantity of tablets provided to you will be determined by your doctor.

Ingredients

Clozaril tablets contain 25 mg or 100 mg of the active ingredient, clozapine.

They also contain:

  • silica colloidal anhydrous
  • talc-purified
  • magnesium stearate
  • lactose
  • maize starch
  • povidone

This leaflet was prepared on the 10 September 2003
(based on approved NZ data sheet dated 11/7/03.)