Clozaril Withdrawal Guidance
Clozaril can cause certain side effects and Clozaril withdrawal symptoms that may be difficult to navigate without assistance or guidance. The drug is not usually a first-line treatment choice but is more often used as an alternative choice where other prescriptions did not work or were not well tolerated due to severe reactions.
There are many important health reasons why it would be wise to research a drug before either starting or stopping a prescription drug, especially one as potent as Clozaril. Regular blood testing is mandatory with the use of Clozaril as well as during Clozaril withdrawal.17 Below you will find information on these and other topics that may be helpful in understanding more about Clozaril and what to expect during Clozaril withdrawal.
SPECIAL NOTE: As with all leftover, expired, or unused prescription medications, please remember not to flush them or place them in regular garbage containers, and do not otherwise allow them to enter the water system in your community. Ask your local friendly pharmacist about the best way to dispose of medications so you can help protect the environment and the health of people around you.
Serotonin Syndrome and Clozaril Withdrawal
Serotonin syndrome or toxicity is a cluster of potentially life-threatening symptoms that is drug-induced. The condition can present with single or multiple serotonergic medications, resulting in too much serotonin. It can also present when abruptly discontinuing a drug such as Clozaril — this action can also flood the CNS with excessive serotonin. Serotonin syndrome can range from mild to severe requiring hospitalization to avert fatality. Symptoms can escalate quite rapidly, over one to six hours, in 30% and 60% of patients, respectively. Symptoms are classified into three main categories outlined below.12,13,14
Mental Status: anxiety, elevated mood, hypomania, confusion, impaired consciousness, restlessness, insomnia.
Neuromuscular excitation: seizure, agitation, rigidity, lack of muscle control, hyperreflexia, uncontrolled twitching, jerking, spastic movements, akathisia, hyperkinesis, repeating twisting motions of the neck or other muscles, ocular clonus (roving eye movement), dorsiflexion of the ankle, toes, or foot, if prolonged may progress to muscle rigidity.
Autonomic nervous system dysfunction: cardiac collapse leading to death, tachycardia, vomiting, diarrhea, dilated pupils, tremors, incoordination, shivering, sweating, fever, hypertension, renal failure, metabolic acidosis, acute respiratory distress.
The potential severity of these symptoms that should be watched for during Clozaril withdrawal has been sufficiently researched for educated medical personnel to be alert to serotonin syndrome and the need for hospitalization immediately should it present.
What Is Clozaril (clozapine) Used For?
Clozaril is used in the treatment of certain mental disorders, where other (usually at least two) other antipsychotic medications have not worked, or where the side effects were too harsh and could not be tolerated by the patient. A candidate for a prescription of Clozaril could be someone diagnosed with conditions such as:
- Treatment-resistant schizophrenia 1,15
- Treatment-resistant schizoaffective disorder with a known risk for suicide.1,15
- Please note that elderly patients with dementia-related psychosis should NOT be prescribed Clozaril (or other antipsychotic medications) due to the increased risk of death.1,15
Clozaril (clozapine) Alternative Names and Slang
Clozaril is the brand name for the active ingredient, clozapine. Other brand names include Clopine©, Clozapine Synthon©, and FazaClo©. Although the names may be different, the Clozaril withdrawal symptoms are common to other brand name versions.
Clozaril (clozapine) Side Effects
There are hundreds of known side effects of antipsychotic medications. Some of these overlap the list of Clozaril withdrawal symptoms. We will list Clozaril-specific side effects both physiological and psychological or mixed adverse effects, with the caution that this is not a complete list, as follows:
Risk of death in elderly patients with dementia (clozapine is not approved for this population)1,15- Agranulocytosis: a drug-induced, life-threatening lowering of white blood cell count often marked by lethargy, fever, weakness, or other signs of infection.1,15,16,23
- Eosinophilia: An abnormal increase in certain (two-lobed) white blood cells, often accompanied by asthma or other allergic symptoms resulting from toxic excretions of these immune cells as the Clozaril reaction turns these cells against their host, the patient. This condition may be more prevalent in women according to the research of Banov et al published in the Journal of Clinical Psychiatry in 1993.1,15,25
- Seizures: patients are advised not to drive or operate machinery, etc., due to the risk of losing consciousness due to seizures on Clozaril.1,15
- Myocarditis: inflammation of the heart muscle, negatively affecting the electrical action and ability of the heart to pump blood. Clots can form in and around the heart leading to heart failure and death. The rate of myocarditis has been documented from 17–322 times greater in patients on Clozaril than in the general population.1,15
- Orthostatic hypotension: drop in blood pressure associated with collapse and respiratory failure.1,15,16
- Cardiac events: such as tachycardia (elevated heart rate), ischemic changes (narrowing of the arteries), myocardial infarction (stoppage of blood flow within the heart), arrhythmias (irregular slowing or speeding up of heartbeat), congestive heart failure (progressive heart disease that weakens the heart), pericarditis (inflammation of the heart lining), pericardial effusions (collection of fluid in the lining of the heart), and sudden death.1,15,16
- Hyperglycemia: High blood sugar level that may emerge while on Clozaril.1,15
- Diabetes Mellitus: A condition where the body cannot utilize (metabolize) energy from food, resulting in fatigue, weight loss, headaches, tingling or numbness in the hands and feet, etc.1,15
- Neuroleptic Malignant Syndrome or NMS: A potentially fatal reaction to antipsychotic medications marked by irregular or racing heartbeat and diaphoresis (heavy sweating), hyperpyrexia (body temperature over 106°F or 41.1°C), rigid muscles, and altered mental state.1,15
- Tardive dyskinesia: A potentially irreversible condition linked to antipsychotic medications, involving involuntary dyskinetic (jerky, spasmodic) muscle motions. The hands and feet may appear to be thrashing in a quick or dance-like manner. Motions in the face and tongue appear as rolling or brief intermittent and irregular writhing or twisting characteristics.1,15
- Cardiomyopathy: Refers to heart disease resulting in thickened or rigid heart muscles.1,15
- Pulmonary embolism: potentially fatal clotting causing a blockage in the lung which results in blockage of blood flow.1,15
- Hepatitis: Clozaril is associated with hepatitis whether or not a patient has had a history of liver disease before starting the drug.1,15
- Urinary incontinence.16
- Cognitive and Physical Motor Impairment: Due to the sedating effects of Clozaril patients can experience significant cognitive and physical movement impairment on the drug.1,15,16
Warning regarding pregnancy and nursing mothers: Clozaril can be excreted into breast milk and should not be taken while nursing. No human studies have been performed on harm to the fetus, but the drug is not FDA recommended for mothers nursing their infant.1,15- Impaired CNS: Includes adverse side effects such as sedation, akathisia, vertigo, headache, tremor, nightmares, insomnia, agitation, convulsions, rigidity, slurred speech, etc.1,15
- Gastrointestinal: Constipation, nausea, heartburn, abdominal pain, vomiting, diarrhea, anorexia, etc.1,15,16
- Other adverse effects: Include fever, rash, sexual dysfunction, respiratory issues, shortness of breath, numbness in the tongue, weight gain, shortness of breath, nasal congestion, drooling, sweating, dry mouth, visual disturbances such as blurred vision, etc.1,15,16
Additional Notes on Clozaril Withdrawal Symptoms
Several studies such as have suggested that women and the elderly are more at risk of withdrawal symptoms and certain adverse effects of Clozaril than other cohorts.21,25
Clinical research has shown that withdrawals may only emerge some weeks after abrupt Clozaril cessation, leaving some physicians unaware of the consequences for their patients of suddenly stopping Clozaril. In contrast, involuntary movement disorders, delirium, agitation, and other serious Clozaril withdrawal symptoms have been reported immediately after abruptly stopping Clozaril in some patients. These reactions are thought related to a surge in dopamine if Clozaril withdrawal is too abrupt.6
Studies published from the 1960s right up to current times all suggest that slow tapering is the very best route for easing Clozaril withdrawal.19-21
How Long does Clozaril Withdrawal Last?
A significant number of individuals stop Clozaril due to side effects that become intolerable and outweigh any perceived benefit. Compounding the problem, persons stopping Clozaril too quickly have often reported a rapid deterioration in their mental state, especially without proper guidance for gradual withdrawal. Sometimes these withdrawal symptoms are misdiagnosed as a relapse, leading to subsequent treatment errors. Clozaril is one of the most troublesome antipsychotic medications due to the severity of withdrawals that can emerge after abrupt discontinuation. This is why slow, gradual Clozaril withdrawal is the best approach.
Except in circumstances where a life-saving intervention indicates sudden cessation, as discussed in more detail below in the section entitled “Discontinuing/Quitting Clozaril—Can You Just Stop Taking Clozaril?,” the FDA advises never to abruptly stop taking an antipsychotic agent such as Clozaril.
Clozaril withdrawal symptoms can be mild or severe and may begin quite soon after forgetting a dose when tapering from Clozaril, but they can also happen after a considerable lapse of time has occurred post-discontinuation. There is no one-size-fits-all Clozaril withdrawal timeline. Constant monitoring and careful, gradual titration is considered the best practice for coming off Clozaril and other antipsychotic medications.19-21
Discontinuing/Quitting Clozaril — Can You Just Stop Taking Clozaril?
There are circumstances where immediate withdrawal of Clozaril is medically needed as a life-saving intervention. These include potentially life-threatening adverse reactions to the drug which are delineated in detail under the adverse effects section, for instance, cardiovascular compromise, risk of stroke, signs of tardive dyskinesia, and other severe reactions.
In the vast majority of cases, gradual Clozaril tapering methods are recommended for coming off Clozaril in the safest way.
Always seek medical guidance and direction from your doctor before making changes to medications.
It has been found that Clozaril binds to certain receptors in the brain and central nervous system (CNS) and that this action alters the way the body and brain receive and transmit messages and commands along nerve channels.
We understand that dependence on a potent antipsychotic drug must be treated with caution with respect to the risks that can accompany even a slow taper. We have helped clients overcome these formidable barriers utilizing gradual Clozaril withdrawal, supported by nutrition-based, individualized, compassionate treatment methods.
