Clozapyl 100 torrent drugs for chronic schizophrenia (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Clozapine
Ingredient Schizophrenia

Ingredient

Composition information	Content
Clozapine	100mg

Uses

indications

Clozapyl - 100 drugs are indicated in the following cases:

Treatment of anti -drug schizophrenia or in tolerance of classical drugs.

Pharmacokology

Clozapine is classified as not typical mental inhibitors because the drug has the ability to link to the Dopamine receptor and the drug has many other effects with more typical nervous inhibitors on a lot of Dopamine dependent reactions of the body.

Specifically, although clozapine works to prevent the connection of dopamine at the receptors D1, D2, D3 and D5 and have high affinity with the D4 receptor, it does not cause the position to keep the posture and does not inhibit the repetitive behavior as when treated with apomorphine. This is consistent with the view that clozapine prioritizes the effects on the receptors of dopamine in the limbic region rather than the receptors in the pattern area and therefore can help explain why clozapine has little effects of foreign tower.

Clozapine also acts as an antagonist on adrenergic receptors, cholinergic, histaminergic and serotonergic.

Pharmacokinetics

absorption

In humans, clozapyl tablets (25 mg and 100 mg) have a bioavailability equivalent to the type of clozapine solution. With a dose of 100 mg x 2 times/day, the peak concentration of a stable state in plasma has an average value of 319 ng/ml (the range of oscillation is from 102 - 771 ng/ml), this concentration is achieved after an average of about 2.5 hours (about 1 - 6 hours) after using the drug.

Also at this dose, the minimum concentration of stable state in plasma is an average value of 122 ng/ml (the range of oscillation is from 41 - 343 ng/ml) 100 mg x 2 times/day. Food does not affect the bioavailability of clozapyl so you can take medicine during or outside the meal.

Distribution

about 97% clozapine binds to serum protein. The interaction between clozapyl and large -sized drugs with protein has not been fully evaluated but may be very important.

Metabolism

Clozapine is metabolized almost completely before being eliminated and it is found that the unprovent form of the drug in the form of stains in the feces and urine. About 50% of the drug used is excreted in urine and 30% in feces.

Demethyl chemical, hydroxylation and n - oxidant drug derivatives are the main ingredients detected both in urine and feces. Pharmacological testing has shown that demethyl chemical metabolites are only very little effect and the metabolites of hydroxylation and n - oxidation are absolutely not effective.

Elimination

If only a single dose of 75 mg, the average selling time of clozapine is 8 hours (the range is from 4 to 12 hours) while if using the dose of 100 mg x 2 times/day, after achieving the average stability of the drug's sale time of 12 hours (the range of oscillation is from 4 - 66 hours).

Test comparing the use of clozapine by single dose and multi -dose has shown that the sale time increases when using clozapine in the multi -dose compared to when used by single dose, proving that the ability of the pharmacokinetics of the drug is dependent on concentration. At the dose levels of 37.5 mg, 75 mg and 150 mg x 2 times/day after reaching a stable state, AUC is found (area under the curve), peak concentration and minimum concentration in plasma ratio ratio to the dose.

Before taking Clozapyl 100 torrent drugs for chronic schizophrenia (10 blisters x 10 tablets)

How to use

use by oral.

Dosage

Adults

Starting dose: 12.5 - 25 mg/day.

Increase dose: 25 - 50 mg daily until reaching 300 - 450 mg/day for 14 days.

(Note: With the dose levels

Maximum dose: Some patients are treated at higher doses than the above -mentioned dose level and the highest dose allowed to be used is 900 mg/day. However, unwanted effects tend to increase when the patient uses a dose of more than 450 mg/day.

Children

The drug is not recommended for children.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?

Symptoms

Destiny, sleep, coma, loss of reflexes, confusion, agitation, intense reflexes, delirium, convulsions, increased saliva secretion, pupils, blurred vision, non -tolerant heart rate, hypotension, depression, arrhythmia and respiratory failure.

Overdose

Includes gastric lavage then for patients to drink activated carbon, symptomatic treatment combined with continuous monitoring of cardiovascular and respiratory function, electrolyte control and acid -base balance. Adrenalin should not be used as well as its derivatives to treat symptoms of hypotension and are likely to appear "reversing the effect of adrenalin". Patients also need to be closely monitored for at least 4 days to prevent late counterattack.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Clozapyl - 100, you may experience unwanted effects (ADR).

Dizziness and fatigue is the most common side effect when taking the drug. The other unwanted effects of the drug on the central nervous system are epilepsy, dizziness and headache.

Symptoms caused by drugs are caused by drugs, including: trembling, sitting restless and stiff. All of these effects are light and transient.

There have been reports on the appearance of symptoms such as dry mouth, sweating disorders and regulating body temperature when taking the drug.

Side effects of the drug on the cardiovascular system tachycardia, hypotension with special posture often appear in the first weeks of the treatment process.

Although very rare, the circulatory failure accompanied by respiratory failure due to drug use has also been reported.

On the digestive tract, side effects such as nausea, vomiting and constipation can also occur. It is also possible to encounter the case of increasing liver enzyme and in very few cases may have biliary obstruction.

Instructions on how to handle ADR

The ADR is largely due to the pharmacological effect of clozapin, except for granulocytes. Due to this risk, Clozapin is only for the treatment of schizophrenia that does not respond to other drugs and psychosis that appears during the treatment of Parkinson's disease. Although some ADRs often appear when the dose is reduced or stopped, some other ADR may not recover and may be rare. Due to grain leukemia is a real risk due to clozapin, which can last throughout the treatment period and even when the drug is stopped, and can be fatal if not detected early and stop the drug in time, so before, during and after treatment with clozapine, it is required to have the conditions to test the number of white blood cells and the absolute amount of white blood cells.

If the number of leukocytes

If the number of eosinophilia increases> 4000 cells/mm3, the temporary suspension of clozapin must be temporarily stopped until the number of eosinophilia decreases to

Clozapin convulsions may be related to the increase in the drug too fast, especially in people with a history of epilepsy or use simultaneously drugs that increase the concentration of clozapin in plasma. If convulsions or convulsions appear to reduce clozapin dose and use anti -convulsions if necessary.

Drowsiness usually occurs during clozapin treatment but usually gradually decreases after 1-4 weeks of treatment and usually runs out if the treatment lasts for a long time. To overcome, the drug can be used before going to bed.

Sudden stopping of the drug (as in the case of leukopenia or leukocytosis) may cause symptoms of psychosis again. Can be overcome by taking another anti -psychotic drug. Fever> 38 ° C in the first 3 weeks, usually appears in the middle of 5 - 20 treatment.

Fever is usually benign and self. However, it is necessary to be careful to distinguish from the fever due to the infection and to closely check the blood count. The tachycardia, hypotension with vertical or not accompanied by fainting, especially may appear in the first weeks of treatment, often due to rapid increase and strong dose of clozapin. The risk of hypotension can decrease by low doses and then gradually increase the dose in moderate levels.

The tachycardia may last throughout the treatment period, but if the fast heartbeat lasts continuously at the time of rest, accompanied by chest drums, arrhythmia, chest pain, idiopathic fatigue, shortness of breath, rapid breathing, fever, it is necessary to think of clozapine myocarditis and must stop the drug immediately.

Weight gain may appear during treatment. Need to guide the diet and exercise regime for patients during medication.

Increase salivation, a normal reaction of the drug, usually decreasing for a few weeks. Constipation if there is often symptomatic treatment.

Do not use meclopramid to treat vomiting if appearing during treatment due to the risk of Parkinson's syndrome and late dysfunction.

Due to the risk of severe hyperglycemia, sometimes combined with ketone coma, increased absorbent pressure in patients using clozapin, it is recommended that patients with diabetes, or people at risk of diabetes (obesity, family history of diabetes) must check blood sugar at hunger before and during clozapine treatment.

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Clozapyl drug - 100 contraindicated in the following cases:

Patients with hypersensitivity to the ingredients of the drug.

Patients with a history of grain leukemia or hemorrhage disorders in bone marrow.

Patients with mental disorders due to alcoholism or toxicity, patients with drug poisoning, in coma and severe central neurasthenia, patients with severe liver and liver disease.

Be cautious when using

clozapyl can cause grain leukocytes. Before starting treatment with clozapyl patient, the patient should be tested to determine the number and white blood cell formula. The determination of the number of white blood cells should be conducted during the treatment period and even must be continued after the treatment has ended, the number of white blood cells needs to be tested weekly for 4 months and then every half a month until the end of 4 weeks after the treatment is stopped.

The ability to drive and operate machinery

should be cautious when used for driving objects and operating machinery.

Pregnancy

so far, the safety of clozapine for pregnant women has not been proven so the drug has not been recommended for these subjects.

Breastfeeding period

Animal studies show that clozapine is excreted into milk, so mothers are being treated with clozapine should not breastfeed.

Medicinal interaction

clozapyl can increase the effect on the central nervous system: alcohol, enzyme inhibitors, central neurological inhibitors such as addictive painkillers, benzodiazepine and H1 anti -histamine drugs. Caution should be used when using clozapyl in patients who are (or just) using benzodiazepine because the combination of drugs can increase the risk of circulatory failure with respiratory failure.

Due to side effects, it is also necessary to use the kidneys while using clozapyl simultaneously with drugs that have anti -cholinergic effects, lower blood pressure or respiratory inhibitors. Some other drugs have the effect of impaired function of bone marrow (for example: carbamazine, captopril and propylthiouracil) may increase the risk of granulocytes if used simultaneously with clozapine.

Storage

Store at temperatures below 30 ° C. Avoid light.

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