Rare serious adverse effects of clozapine (tur)

Clozapine remains still the gold standard agent for treatment-resistant schizophrenia. In addition to its proven efficacy on both positive and negative symptoms in refractory schizophrenia, clozapine is useful in reducing aggressive behavior, hostility, comorbid use of alcohol and drugs, as well as reducing suicidality in schizophrenia. It has significant dopaminergic, serotonergic, adrenergic, muscarinic and histaminic blocking properties; and thus most of its adverse effects can be predicted on the basis of its pharmacological profile. Despite its demonstrated efficacy in schizophrenia, the widespread use of clozapine has been limited by the potential for adverse effects. Clozapine can cause reversible neutropenia, which may progress to potentially fatal agranulocytosis. Other potentially serious adverse effects of clozapine include seizures, myocarditis, and cardiomyopathy. Less serious and more common side effects of clozapine including sedation, hypersalivation, tachycardia, hypotension, hypertension, weight gain, gastrointestinal hypomotility, urinary incontinence, and fever can often be managed medically and are generally tolerated by the patient. These side effects often lead either to non-compliance or discontinuation of treatment by patients. The majority of patients did not report that the side effects affect their activities of daily living or they cause personal distress. Appropriate management of clozapine side effects facilitates the maximization of the benefits of clozapine treatment, and physicians and patients alike should be aware that there is a range of benefits to clozapine use that is wider than its risks. The aim of this article is to provide an update by focusing on the potentially life-threatening side effects of clozapine.