Performance Comparison of Microfluidic and Immunomagnetic Platforms for Pancreatic CTC Enrichment
November 15, 2025
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Brand Name :
Clozaril
(United States) [Available]Synonyms :
Clozapina, Clozapinum, Clozapin
Class :
Antipsychotics, Second Generation
Brand Name :
Clozaril
(United States) [Available]Synonyms :
Clozapina, Clozapinum, Clozapin
Class :
Antipsychotics, Second Generation
Dosage Forms & Strengths
Tablet
25 mg
50 mg
100 mg
200 mg
Oral suspension
50mg/ml
Take a dose of 12.5 mg orally one time a day; raise the dose up to 25 to 50 mg daily and if well tolerated
To achieve target dose of daily 300 to 450 mg is administered in divided doses by completion of two weeks
It may raise dose one or two times in week up to 100 mg and a daily dose not more than 900 mg
Dosage Modifications
For Coadministration with CYP inhibitors
Strong CYP1A2 inhibitors: Use one-third part of clozapine dose
Moderate or weak CYP1A2 inhibitors: decrease clozapine dose if required
CYP2D6 or CYP3A4 inhibitors: decrease clozapine dose if required
CYP2D6 poor metabolizers: decrease clozapine dose if required
For Coadministration with CYP inducers
Strong CYP3A4 inducers: Coadministration not suggested
Moderate or weak CYP1A2 or CYP3A4 inducers: increase clozapine dose if required
For Renal or hepatic impairment
Decreased dose may be required
Dosing Considerations
Before starting, obtain complete blood count with differential for initial absolute neutrophil count to maintain therapy, absolute neutrophil count must be regularly monitored
Off-label::
274 to 155 mg once a day
Safety and efficacy not determined
Refer to adult dosing
may diminish the therapeutic effect of anti-parkinson agents
may diminish the therapeutic effect of anti-parkinson agents
may diminish the therapeutic effect of anti-parkinson agents
may diminish the therapeutic effect of anti-parkinson agents
may diminish the therapeutic effect of anti-parkinson agents
may diminish the serum concentration of CYP3A4 Inducers
may have an increased constipating effect when combined with clozapine
may have an increased constipating effect when combined with clozapine
may have an increased constipating effect when combined with clozapine
may have an increased constipating effect when combined with clozapine
may have an increased constipating effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with clozapine
clofazimine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
clofazimine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
clofazimine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
clofazimine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
clozapine: they may increase the toxic effect of benzodiazepines
clozapine: they may increase the toxic effect of benzodiazepines
clozapine: they may increase the hypotensive effect of blood viscosity reducing agents
clozapine: they may increase the hypotensive effect of blood viscosity reducing agents
clozapine: they may increase the CNS depressant effect of CNS Depressants
clozapine: they may increase the CNS depressant effect of CNS Depressants
clozapine: they may increase the CNS depressant effect of CNS Depressants
clozapine: they may increase the CNS depressant effect of CNS Depressants
clozapine: they may increase the CNS depressant effect of CNS Depressants
clozapine: they may increase the bradycardic effect of Bradycardia-Causing Agents
clozapine: they may increase the bradycardic effect of Bradycardia-Causing Agents
clozapine: they may increase the bradycardic effect of Bradycardia-Causing Agents
clozapine: they may increase the bradycardic effect of Bradycardia-Causing Agents
clozapine: they may increase the bradycardic effect of Bradycardia-Causing Agents
may enhance the CNS depressant effect
may increase the constipating effect of anticholinergic agents
may increase the constipating effects of anticholinergic agents
may increase the CNS depressants effects of CNS depressants
acrivastine and pseudoephedrine
may increase the constipating effect of anticholinergic agents
may increase the constipating effect of anticholinergic agents
may increase the constipating effect of anticholinergic agents
may increase the constipating effect of anticholinergic agents
may increase the constipating effect of anticholinergic agents
may increase the serum concentration when combined
may increase the constipating effect of Anticholinergic Agents
may diminish the serum concentration of CYP3A4 Inducers
may increase the constipating effect of Anticholinergic Agents
acetaminophen/doxylamine/dextromethorphan
may increase the constipating effect of Anticholinergic Agents
ciprofloxacin inhaled (Pending FDA approval)
may increase the QTc-prolonging effect of Ciprofloxacin
adagrasib: they may increase the QTc-prolonging effect of clozapine
amiodarone: they may increase the QTc-prolonging effect of clozapine
carbamazepine: they may increase the myelosuppressive effect of clozapine
aminoglutethimide reduces the concentration of clozapine in serum
may have an increased risk of gastrointestinal motility when combined with tropicamide
it may enhance the qtc interval when combined with lofexidine
clozapine together with cisapride lead to an elevation of the QTc interval
when both drugs are combined, there may be an increased risk or severity of neutropenia
when both drugs are combined, there may be an increased metabolism of vincristine
when both drugs are combined, there may be an increased risk or severity of neutropenia
when both drugs are combined, there may be an increased risk or severity of neutropenia
when both the drugs are combined, the risk or severity of neutropenia increases
immunosuppressants such as doxorubicin may enhance the immunosuppressive effect of another drug
When both drugs are combined, there may be an increased risk or severity of neutropenia
when both drugs are combined, there may be an increased risk or severity of QTC prolongation
when both drugs are combined, there may be an increased risk or severity of neutropenia
when both drugs are combined, there may be reduced levels of white blood cell count
immunosuppressants such as doxorubicin may enhance the immunosuppressive effect of another drug
when both drugs are combined, the risk or severity of neutropenia increases
when both drugs are combined, there may be an increased risk or severity of neutropenia
when both drugs are combined, there may be an increased risk or severity of adverse effects
when both drugs are combined, both increase the QTC interval
when both drugs are combined, both increase the QTC interval
may raise the risk of neutropenia due to myelosuppression
clozapine
may raise the risk of neutropenia due to myelosuppression
CYP3A strong enhancers of the small intestine may reduce the bioavailability of clozapine
when both drugs are combined, there may be an increase in the QTC interval
immunosuppressants such as doxorubicin may enhance the immunosuppressive effect of another drug
they both increase the effect of each other when used simultaneously
they both increase the effect of each other when used simultaneously
CNS depressants increase the effect of orphenadrine
it increases the effect of CNS depressants
CNS depressants increase the CNS depressing effect of thalidomide
CNS depressants increase the effect of flunarizine
it increases the effect of CNS depressants
It may enhance QTc interval when combined with pentamidine
may enhance the risk of hypertension when combined with clozapine
saquinavir: they may increase the QTc-prolonging effect of clozapine
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
may increase the CNS depressant effect of cannabinoid-containing products
may increase the CNS depressant effect of cannabinoid-containing products
may increase the CNS depressant effect of opioid agonists
may increase the CNS depressant effect of opioid agonists
may increase the CNS depressant effect of opioid agonists
may decrease the levels of serum concentration of clozapine
may decrease the levels of serum concentration of clozapine
may decrease the levels of serum concentration of clozapine
may decrease the levels of serum concentration of clozapine
may decrease the levels of serum concentration of clozapine
may increase the serum concentration of clozapine
may increase the serum concentration of clozapine
may increase the serum concentration of clozapine
may increase the serum concentration of clozapine
may increase the serum concentration of clozapine
may have an increased adverse effect when combined with clozapine
may have an increased adverse effect when combined with clozapine
may have an increased adverse effect when combined with clozapine
may have an increased adverse effect when combined with clozapine
may have an increased adverse effect when combined with clozapine
It may diminish the effects when combined with chasteberry by pharmacodynamic antagonism
clozapine: they may enhance the serum concentration of CYP1A2 Inhibitors
clozapine: they may enhance the serum concentration of CYP1A2 Inhibitors
clozapine: they may enhance the serum concentration of CYP1A2 Inhibitors
clozapine: they may enhance the serum concentration of CYP1A2 Inhibitors
clozapine: they may enhance the serum concentration of CYP1A2 Inhibitors
It may decrease the therapeutic effect when combined with Alpha-/Beta-Agonists
It may decrease the therapeutic effect when combined with Alpha-/Beta-Agonists
It may decrease the therapeutic effect when combined with Alpha-/Beta-Agonists
It may decrease the therapeutic effect when combined with Alpha-/Beta-Agonists
It may decrease the therapeutic effect when combined with Alpha-/Beta-Agonists
It may diminish the effect when combined with griseofulvin by CYP3A4 metabolism
may have an increased QTc-prolonging effect when combined with clozapine
it may diminish the excretion rate when combined with gadofosveset, resulting in an enhanced serum level
when ajmaline is used together with clozapine, the risk or seriousness of QTc prolongation is enhanced
When clozapine is used together with bromisoval, the risk or seriousness of CNS depression is enhanced
The potential for CNS depression may enhanced when clozapine is used together with fencamfamin
Combining tegafur with clozapine can reduce tegafur’s metabolism
When clozapine is used together with niaprazine, the risk or seriousness of CNS depression is enhanced
When clozapine is used together with levosulpiride, the risk or seriousness of CNS depression is enhanced
When dexrabeprazole and clozapine is used together, this leads to reduction in the dexrabeprazole’s metabolism
clozapine: they may enhance the serum concentration of CYP3A4 Inhibitors
clozapine: they may enhance the serum concentration of CYP3A4 Inhibitors
clozapine: they may enhance the serum concentration of CYP3A Inhibitors
clozapine: they may enhance the serum concentration of CYP3A Inhibitors
clozapine: they may enhance the serum concentration of CYP3A Inhibitors
clozapine: they may enhance the serum concentration of CYP3A Inhibitors
clozapine: they may enhance the serum concentration of CYP3A Inhibitors
clozapine: they may enhance the serum concentration of CYP2D6 Inhibitors
clozapine: they may enhance the serum concentration of CYP2D6 Inhibitors
clozapine: they may enhance the serum concentration of CYP2D6 Inhibitors
clozapine: they may enhance the serum concentration of CYP2D6 Inhibitors
clozapine: they may enhance the serum concentration of CYP2D6 Inhibitors
When clozapine is used together with melitracen, this leads to enhanced risk or seriousness of CNS depression
When ponesimod is used together with clozapine, this leads to enhanced risk or seriousness of bradycardia
When clozapine is used together with adenosine, this leads to enhanced risk or seriousness of QTc prolongation
When clozapine is used together with givinostat, this leads to enhanced risk or seriousness of Qtc prolongation
When emylcamate is used together with clozapine, this leads to enhanced risk or seriousness of CNS depression
When clozapine is used together with oleandomycin, this leads to enhanced concentration serum of clozapine
When clozapine is used together with patupilone, this leads to enhanced concentration serum of clozapine
When clozapine is used together with ridaforolimus, this leads to enhanced concentration serum of clozapine
ascorbigen, when used in combination with clozapine, the efficacy of clozapine is lowered
when both drugs combine the risk of both drug increases the toxicity of other by synergism.
Higher risk of bone marrow suppression
may enhance the adverse effects of bone marrow suppression
may enhance the adverse myelosuppressive effects of clozapine
may enhance the adverse myelosuppressive effects of clozapine
when both drugs are combined, there may be an increased effect of cabozantinib by affecting hepatic or intestinal enzyme cyp3a4 metabolism
interaction may increase the risk of neutropenia
QTc interval is increased both by lenvatinib and clozapine
may increase the adverse toxic effects of clozapine
it may increase the bone marrow suppression effect of clozapine
it may increase the adverse effects such as bone marrow suppression activity
myelosuppressive agents increase the toxic or adverse effects of clozapine
myelosuppressive agents increase the toxic/adverse effect of clozapine
may enhance the neurotoxic (central) effect of antipsychotic agents
may enhance the neurotoxic (central) effect of antipsychotic agents
may enhance the neurotoxic (central) effect of antipsychotic agents
may enhance the neurotoxic (central) effect of antipsychotic agents
may enhance the neurotoxic (central) effect of antipsychotic agents
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
CNS depressants increase the toxicity of CNS depressants
may increase the risk of adverse effects of antipsychotic agents
may increase the risk of adverse effects of antipsychotic agents
may increase the risk of adverse effects of antipsychotic agents
may increase the risk of adverse effects of antipsychotic agents
may increase the risk of adverse effects of antipsychotic agents
may increase the QTc interval
may increase the CNS depressant effect
may enhance the risk of adverse/toxic effect of antipsychotic agents
may enhance the risk of adverse/toxic effect of antipsychotic agents
may decrease the absorption of antipsychotic agents
may decrease the absorption of antipsychotic agents
may decrease the absorption of antipsychotic agents
may decrease the absorption of antipsychotic agents
may decrease the absorption of antipsychotic agents
may enhance the serum concentration of CYP3A4 inhibitors
may increase the toxic effect of the myelosuppressive effect
may increase the toxic effect of myelosuppressive agents
may increase the adverse effect of Myelosuppressive Agents
may increase the toxic effect of Immunosuppressants
the rate of metabolism may be altered
When clozapine is aided by hesperetin, it reduces hesperetin’s metabolism
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the constipating effect of clozapine
anticholinergic agents increase the constipating effect of clozapine
anticholinergic agents increase the constipating effect of clozapine
anticholinergic agents increase the constipating effect of clozapine
anticholinergic agents increase the constipating effect of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
anticholinergic agents increase the effect of constipation of clozapine
CNS depressants increases the toxicity of bupivacaine
Actions and Spectrum
clozapine acts as an antagonist at dopamine receptors, specifically D2 receptors. By blocking these receptors, it helps to reduce the excessive dopamine activity associated with schizophrenia symptoms.
Frequency defined
1-10%
Syncope (6%)
Sweating (6%)
Fatigue (2%)
Diarrhea (2%)
Urinary abnormalities (2%)
Dry mouth (5-6%)
Leukopenia/neutropenia (3%)
Restlessness (4%)
Akathisia (3%)
Confusion (3%)
Hypertension (4%)
Rash (2%)
Abdominal discomfort/heartburn (4%)
Headache (7-10%)
Seizures (3%)
Rigidity (3%)
Visual disturbances (5%)
Hypokinesia/akinesia (4%)
Agitation (4%)
Disturbed sleep/nightmares (4%)
Tremor (6%)
>10%
Sedation/somnolence (21-46%)
Insomnia (2-20%)
Hypotension (9-13%)
Fever (5-13%)
Nausea (17%)
Dizziness (14-27%)
Dizziness/vertigo (19%)
Vomiting (17%)
Dyspepsia (14%)
Constipation (14-25%)
Tachycardia (17-25%)
Weight gain (4-31%)
Hypersalivation (13-48%)
Post marketing Reports
Musculoskeletal system: Rhabdomyolysis, systemic lupus erythematosus, myasthenic syndrome
Skin: Erythema multiforme, Hypersensitivity reactions, Stevens-Johnson Syndrome, photosensitivity, vasculitis, skin pigmentation disorder
Gastrointestinal system: Acute pancreatitis, dysphagia, megacolon, intestinal obstruction, ischemia, infarction, perforation, salivary gland swelling, colitis, hypersalivation, dry mouth, ulceration
Central nervous system: Tardive dyskinesia, neuroleptic malignant syndrome, restless leg syndrome, Delirium, EEG abnormal, myoclonus, paresthesia, possible cataplexy, status epilepticus, obsessive compulsive symptoms
Hepatobiliary: Hepatic fibrosis, hepatic cirrhosis, liver injury, hepatotoxicity, hepatic steatosis, hepatic necrosis, liver failure
Urogenital: Renal failure, priapism, retrograde ejaculation, nocturnal enuresis, acute interstitial nephritis
Hemic and lymphatic system: DVT, ESR, sepsis, angioedema, leukocytoclastic vasculitis, eosinophilia, pulmonary embolism, thrombocytosis, thrombocytopenia
Vision disorders: Narrow-angle glaucoma
Cardiovascular: Atrial or ventricular tachycardia or fibrillation, periorbital edema, myocardial infarction, mitral valve incompetence, bradycardia, cardiomyopathy, myocarditis, cardiac arrest, QT prolongation, hypertension
Immune system disorders: Angioedema, leukocytoclastic vasculitis
Miscellaneous: CPK elevation, weight loss, polyserositis, hyperuricemia, hyponatremia
Endocrine system: Pseudo pheochromocytoma
Respiratory system: Pneumonia, lower respiratory tract infection (LRTI), Aspiration, pleural effusion
Clozapine is linked with a major risk of agranulocytosis. It is a condition in which WBCs count decreases severely. It has a potential to reduce the threshold of seizure. Caution must be taken in patients who have history of seizures.
Usage of clozapine is linked with myocarditis and cardiomyopathy disease.
Contraindication/Caution:
Contraindication:
Caution:
Pregnancy consideration:
Pregnancy category: N/A
Lactation: It present in human milk
Pregnancy Categories:
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.
Category N: There is no data available for the drug under this category.
Pharmacology
It exhibits weak D2- and D1-receptor blocking activity, but it has important nor adrenolytic, anticholinergic, antihistaminic, and arousal reaction suppressing actions. It also has antiserotoninergic properties.
The significant effects in controlling behavioral and mental symptoms with low incidence of EPS are attributed to affinity for mesolimbic dopamine D4 receptors.
Pharmacodynamics
clozapine exhibits antagonistic activity at alpha-1 adrenergic receptors. Clozapine acts as an antagonist for histamine H1 receptors.
Pharmacokinetics
Absorption
clozapine is absorbed after oral administration, with peak plasma concentrations reached within 1.5 to 2.5 hours.
Distribution
clozapine has a high level of protein binding of 97% to albumin and alpha-1-acid glycoprotein.
Metabolism
clozapine undergoes metabolism in the liver, through the cytochrome P450 (CYP) enzyme system.
Elimination and excretion
clozapine and its metabolites are excreted in the urine. The elimination half-life of clozapine ranges from 8 to 12 hours.
Clozapine is administered orally as a tablets and suspension forms. stered orally in the form of tablets and suspension.
Generic Name: clozapine
Why do we use clozapine?
clozapine is used in the treatment of schizophrenia, particularly in cases that are resistant to other antipsychotic drugs.
clozapine has found effective in reducing the risk of suicidal behaviour in patients with schizophrenia.
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