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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by ed_uk on November 29, 2004, at 10:42:42
Anyone ever used clozapine (Clozaril/Leponex) to treat schizophrenia, schizoaffective disorder or bipolar?
Ed.
Posted by linkadge on November 29, 2004, at 13:04:34
In reply to Clozapine, posted by ed_uk on November 29, 2004, at 10:42:42
This is probably the best antipsychotic out there. It does have a potentially dangerous side effect, but nonetheless.
It has some potent 5-ht1a agonism, which other AP's don't have.
Linkadge
Posted by zeugma on November 29, 2004, at 18:48:01
In reply to Re: Clozapine, posted by linkadge on November 29, 2004, at 13:04:34
I would bet clozapine would make a good last-ditch AD as well as AP and bipolar treatment.
notably, it is the only AP that has been proven not to induce TD.
One the downside, it requires weekly blood tests for white-cell count monitoring. Given that this drug has been shown to sometimes REVERSE TD, a dreadful side effect of all other AP's, I am glad this drug didn't go the way of nomifensine and other drugs that carry serious risks but potentially incaculable benefits.
Posted by lostforwards on November 29, 2004, at 19:11:59
In reply to Re: Clozapine, posted by zeugma on November 29, 2004, at 18:48:01
I've heard of it reversing TD but how does it do it? What makes it so different from the other APs? Is there something special about the way it blocks dopamine receptors?
Posted by zeugma on November 29, 2004, at 19:28:25
In reply to Re: Clozapine » zeugma, posted by lostforwards on November 29, 2004, at 19:11:59
> I've heard of it reversing TD but how does it do it? What makes it so different from the other APs? Is there something special about the way it blocks dopamine receptors?
I don't know. It is powerfully anti-muscarinic which is an action of many anti-Parkinsonian drugs- in fact the anti-muscarinic Cogentin is often given for the EPS of older typical AP's. As far as I know, Abilify is the only AP that is a partial agonist at D2 receptors- the others are full antagonists. There is something special about clozapine and the drug companies have been trying to figure this one out for decades. The atypical AP's such as Zyprexa are all attempts to reproduce the therapeutic effects of clozapine without the hematologic complications. But I don't think any of them have been useful in reversing TD, so there's some factor that the chemists have been missing. Clozapine seems like one of those lucky accidents that turn out to be more powerful than the compounds formed in its wake- sort of like the SSRI's are generally weaker AD's than the TCA's and MAOI's (though Lilly etc. will dispute this, of course!).
Posted by ed_uk on November 30, 2004, at 6:08:32
In reply to Re: Clozapine » lostforwards, posted by zeugma on November 29, 2004, at 19:28:25
Hi,
A message to everyone who does not live in the UK.....
Clozapine is prescribed a lot in the UK for schizophrenia. It can only be dispensed from registered pharmacies. Patients who take it have to use the Clozaril Monitoring Service. Before the prescription is dispensed they have to submit their blood test results. Do they use the same system where you live?
Ed.
Another drug which can only be dispensed from hospital pharmacies in England is isotretinoin (Roaccutane/Accutane). Only dermatologists are allowed to prescribe it.
Posted by zeugma on November 30, 2004, at 16:35:53
In reply to Re: Clozapine, posted by ed_uk on November 30, 2004, at 6:08:32
> Hi,
>
> A message to everyone who does not live in the UK.....
>
> Clozapine is prescribed a lot in the UK for schizophrenia. It can only be dispensed from registered pharmacies. Patients who take it have to use the Clozaril Monitoring Service. Before the prescription is dispensed they have to submit their blood test results. Do they use the same system where you live?
>
> Ed.
>
> Another drug which can only be dispensed from hospital pharmacies in England is isotretinoin (Roaccutane/Accutane). Only dermatologists are allowed to prescribe it.I think the company that markets clozapine (Clozaril- I can't imagine there's a generic, for the same reason that generic MAOI's are not available) is required to inform anyone taking the drug that he or she is going to have to have a LOT of blood work done.The reason it is available at all is because psychiatrists lobbied worldwide to have Clozaril reinstated (it was taken off the market for a while). I know that anyone who takes Cylert (pemoline) is required to sign an agreement that he or she is going to have to have regular liver monitoring done and to affirm that Cylert is being taken as a last resort, and I think Clozaril is dispensed on a similar basis. Since this is a condition for the drug's being available at all, I am sure it is a policy followed everywhere, in both cases.
Accutane is notorious in the States for causing depression, and there are many lawsuits currently involving this drug. I don't know if it's been taken off the market in the States or not.
Posted by ed_uk on December 1, 2004, at 7:58:44
In reply to Re: Clozapine » ed_uk, posted by zeugma on November 30, 2004, at 16:35:53
Hi zeugma,
Pemoline was withdrawn from the market in the UK quite a long time ago. A generic clozapine has recently been introduced in the UK but some psychiatrists are concerned that its bioavailability may not be identical to Clozaril, for that reason many people still use the brand Clozaril (Novartis).
Regards,
Ed.
Posted by zeugma on December 1, 2004, at 16:48:37
In reply to Re: Clozapine » zeugma, posted by ed_uk on December 1, 2004, at 7:58:44
> Hi zeugma,
>
> Pemoline was withdrawn from the market in the UK quite a long time ago. A generic clozapine has recently been introduced in the UK but some psychiatrists are concerned that its bioavailability may not be identical to Clozaril, for that reason many people still use the brand Clozaril (Novartis).
>
> Regards,
> Ed.hi Ed,
it is interesting that a generic of clozapine has been introduced in Britain, and also interesting (but less surprising) that it is psychiatrists who are concerned over the generic's bioequivalence to a drug that, nearly a half century after its synthesis, remains the most powerful weapon in the AP arsenal.
Posted by Sebastian on December 1, 2004, at 20:38:43
In reply to Clozapine, posted by ed_uk on November 29, 2004, at 10:42:42
I think thats the one they put me on first in hospital. It gave me TD, could not stop swallowing.
This is the end of the thread.
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