Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
8 - Managing Sedation, Orthostasis and Tachycardia
Published online by Cambridge University Press: 19 October 2021
Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
Summary
In 2016 the United States Food and Drug Administration (FDA) added the category of falls as subsection 5.9 of the Warnings and Precautions listings for all antipsychotic package inserts. This mandated language reflected the concept that changes in blood pressure or alertness may not meet criteria for orthostatic hypotension or sedation as an adverse event during clinical trials, yet together they increase the risk of falling. Increased fall risk, especially among older patients, is one concern related to sedation and orthostasis when starting clozapine, but the other concern is that a patient will find tiredness or dizziness unacceptable when commencing treatment and refuse to continue with clozapine. Using case register data from the South London and Maudsley National Health Service Foundation Trust, it was found that 45% of 316 new clozapine starts from 2007 to 2011 discontinued clozapine within 2 years of initiation. Moreover, 52% of the discontinuations were due to patient decision, and adverse drug reactions were 2.6 times more likely to be the cause than dislike of laboratory visits.
- Type
- Chapter
- Information
- The Clozapine HandbookStahl's Handbooks, pp. 158 - 171Publisher: Cambridge University PressPrint publication year: 2019
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