Klozapin. Status 1989

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Abstract
Clozapine is an atypical neuroleptic with two clinical advantages: it may improve otherwise treatment-resistant schizophrenic patients, and it does not induce extrapyramidal side effects or tardive dyskinesia. Pharmacologically, clozapine is a broad-spectrum neuroleptic that binds to several receptors (dopamine, noradrenaline, serotonin, histamine, and acetylcholine) but which has an exeptionally low binding to D-2 dopamine receptors and a relatively high binding to D-1 receptors as compared with traditional neuroleptics such as halo-peridol. Several controlled clinical trials have demonstrated that, compared with traditional neuroleptics, clozapine is a superior antipsychotic drug in the treatment of severe therapy-resistant schizophrenic patients. In doses up to 600 mg/day no extrapyramidal symptoms or tardive dyskinesia is seen, only some slowing of movements and reduced facial expression. Other side effects include sedation, hypersalivation, orthostatism, tachycardia, anticholinergic symptoms (especially constipation and, in elderly patients, confusion), weight gain, and blood dyscrasia. To ensure the regular control of leukocyte counts and differential together with ECG (weekly during the first month, later every half year), weight, and medication, a special monitoring form is used in most Danish psychiatric institutions. These forms may also be used as a “data bank” for nationwide surveys of the use of clozapine.