From the Guidelines
To treat clozapine side effects and swelling, it is essential to consult your psychiatrist immediately, as they may need to adjust your dosage or prescribe additional medications, and consider the recommendations outlined in the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1. When managing clozapine side effects, it is crucial to prioritize the patient's physical health, as increases in morbidity and mortality related to physical health in individuals with schizophrenia are likely associated with factors such as obesity, diabetes, hyperlipidemia, and reduced engagement in health maintenance 1. For swelling (edema), which commonly affects the legs and ankles, elevating the affected limbs, reducing salt intake, and wearing compression stockings can help, as suggested by general medical principles. Your doctor might prescribe a diuretic like furosemide (20-40mg daily) to reduce fluid retention, considering the patient's overall health and potential interactions with other medications. For other common side effects:
- Constipation can be managed with increased fiber, fluids, and laxatives like docusate sodium (100mg twice daily);
- Sedation often improves with time, but taking clozapine at bedtime helps;
- Excessive salivation may respond to anticholinergic medications like glycopyrrolate (1-2mg twice daily);
- Weight gain requires dietary changes and regular exercise. Regular monitoring of white blood cell counts, blood glucose, and cardiovascular parameters is essential while on clozapine, as recommended by the American Psychiatric Association practice guideline 1. These side effects occur because clozapine affects multiple neurotransmitter systems, including dopamine, serotonin, histamine, and muscarinic receptors, which contribute to its therapeutic effects but also cause various side effects. Key considerations in managing clozapine side effects include:
- APA recommends (1B) that patients with treatment-resistant schizophrenia be treated with clozapine 1;
- APA recommends (1B) that patients with schizophrenia be treated with clozapine if the risk for suicide attempts or suicide remains substantial despite other treatments 1;
- APA suggests (2C) that patients with schizophrenia be treated with clozapine if the risk for aggressive behavior remains substantial despite other treatments 1.
From the FDA Drug Label
Skin and Subcutaneous Tissue Disorders Hypersensitivity reactions: photosensitivity, vasculitis, erythema multiforme, skin pigmentation disorder, and Stevens-Johnson Syndrome. The FDA drug label does not provide direct information on how to treat clozapine side effects and swelling. However, it does list potential side effects, including hypersensitivity reactions.
- Hypersensitivity reactions may be a cause of swelling.
- The label does not provide specific treatment options for these reactions.
- It is essential to consult a healthcare professional for proper evaluation and treatment of clozapine side effects and swelling 2.
From the Research
Managing Clozapine Side Effects
- Most side effects associated with clozapine are typical of antipsychotics in general, and are typically benign, tolerable, and manageable 3
- Side effects can be managed by dose adjustments, and many are observed early after treatment onset and are greatly reduced by dose adjustments 3, 4
- Mandatory blood monitoring has significantly reduced the incidence of agranulocytosis and its associated mortality 3, 4
Treating Specific Side Effects
- Metformin, aripiprazole, and Orlistat (in men only) have been shown to be effective in treating clozapine-induced obesity and metabolic syndrome 5
- Metformin has been shown to reduce body mass index and waist circumference, and can be considered an adjunctive therapy with clozapine to prevent metabolic syndrome in schizophrenic patients 5, 6
- Calorie restriction in combination with an exercise programme may be effective as a non-pharmacological alternative for treating clozapine-induced obesity 5
Common Side Effects
- Sedation, hypersalivation, tachycardia, hypotension, hypertension, weight gain, constipation, urinary incontinence, and fever are common side effects of clozapine, but can often be managed medically and are generally tolerated by the patient 4
- Seizures can occur, but are generally dose-related and can be managed by reduction in clozapine dosage 4