It is mainly used for schizophrenia that does not improve following the use of other antipsychotic medications.
In those with schizophrenia and schizoaffective disorder it may decrease the rate of suicidal behavior.
Typically C-reactive protein (CRP) increases with the onset of fever and rises in the cardiac enzyme, troponin, occur up to 5 days later.
Monitoring guidelines advise checking CRP and troponin at baseline and weekly for the first 4 weeks after clozapine initiation and observing the patient for signs and symptoms of illness.
Clozapine is not recommended for the treatment of behavior problems in older adults with dementia. The risk of developing extrapyramidal symptoms such as tardive dyskinesia is below that of typical antipsychotics; this may be due to clozapine's anticholinergic effects.Extrapyramidal symptoms may subside somewhat after a person switches from another antipsychotic to clozapine.It has been shown to be more effective in reducing symptoms of schizophrenia than typical antipsychotics, with more pronounced effects in those who have responded poorly to other medication.The relapse rate is lower and patient acceptability is better. Common side effects include constipation, bed-wetting, night-time drooling, muscle stiffness, sedation, tremors, orthostatic hypotension, hyperglycemia, and weight gain.
Signs of cardiac failure are less common and may develop with the rise in troponin.A recent case-control study found that the risk of clozapine-induced myocarditis is increased with increasing rate of clozapine dose titration, increasing age and concomitant sodium valproate.