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Fazaclo

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Fazaclo

Fazaclo Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

FazaClo (clozapine) is used to treat severe schizophrenia symptoms in people who have not responded to other medications. It is also used to help reduce the risk of suicidal behavior in people with schizophrenia or similar disorders. It is an antipsychotic medication. Common side effects include drooling, drowsiness, dizziness, headache, shaking (tremor), vision problems (e.g., blurred vision) and constipation. Many of these effects (especially drowsiness) lessen as the body gets used to the medication.

It is recommended that treatment with FazaClo begin with a 12.5 mg dose once or twice daily. The dosing should be continued with daily dosage increments of 25-50 mg/day, if well-tolerated, to achieve a target dose of 300-450 mg/day by the end of 2 weeks. FazaClo may interact with cimetidine, citalopram, lithium, rifampin, blood pressure medications, heart rhythm medications, seizure medicines, antibiotics, atropine, belladonna, clidinium, dicyclomine, scopolamine, or diazepam or similar medicines. Tell your doctor all medications and supplements you use. During pregnancy, FazaClo should be used only when prescribed. Do not stop taking this medication unless directed by your doctor. Babies born to mothers who have used this drug during the last 3 months of pregnancy may infrequently develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice symptoms in your newborn during their first month, tell the doctor. This medication may pass into breast milk and have undesirable effects on a nursing infant. Breastfeeding is not recommended while taking this drug.

Our FazaClo (clozapine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information in Detail?

Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.

Fazaclo in Detail - Patient Information: Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Serious and sometimes fatal infections may occur during treatment with clozapine. Call your doctor right away if you have signs of infection such as:

  • fever, chills, body aches, flu symptoms;
  • mouth and throat ulcers;
  • cough, sore throat;
  • rapid heart rate; or
  • rapid and shallow breathing.

Stop using clozapine and call your doctor at once if you have any of these serious side effects:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;
  • seizure (black-out or convulsions);
  • skin rash, bruising, severe tingling, numbness, pain, muscle weakness;
  • unusual tiredness, trouble breathing;
  • feeling short of breath (even at night or with mild exertion), swelling in your hands or feet;
  • feeling like you might pass out;
  • slow heart rate, weak pulse, slow breathing (breathing may stop);
  • high blood sugar (increased thirst, extreme hunger, fruity breath odor, increased urination, drowsiness);
  • very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors;
  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or
  • nausea, vomiting, loss of appetite, and jaundice (yellowing of your skin or eyes).

Less serious side effects may include:

  • constipation;
  • dry mouth, blurred vision;
  • drooling, especially at night;
  • increased sweating;
  • drowsiness, dizziness, spinning sensation; or
  • sleep problems.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Fazaclo (Clozapine) »

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Fazaclo FDA Prescribing Information: Side Effects
(Adverse Reactions)

SIDE EFFECTS

The following adverse reactions are discussed in more detail in other sections of the labeling:

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The most commonly reported adverse reactions ( ≥ 5%) across clozapine clinical trials were: CNS reactions, including sedation, dizziness/vertigo, headache, and tremor; cardiovascular reactions, including tachycardia, hypotension, and syncope; autonomic nervous system reactions, including hypersalivation, sweating, dry mouth, and visual disturbances; gastrointestinal reactions, including constipation and nausea; and fever. Table 8 summarizes the most commonly reported adverse reactions ( ≥ 5%) in clozapine-treated patients (compared to chlorpromazinetreated patients) in the pivotal, 6-week, controlled trial in treatment-resistant schizophrenia.

Table 8: Common Adverse Reactions ( ≥ 5%) in the 6-Week, Randomized, Chlorpromazinecontrolled Trial in Treatment-Resistant Schizophrenia

Adverse Reaction Clozapine
(N = 126)
(%)
Chlorpromazine
(N = 142)
(%)
Sedation 21 13
Tachycardia 17 11
Constipation 16 12
Dizziness 14 16
Hypotension 13 38
Fever (hyperthermia) 13 4
Hypersalivation 13 1
Hypertension 12 5
Headache 10 10
Nausea/vomiting 10 12
Dry mouth 5 20

Table 9 summarizes the adverse reactions reported in clozapine-treated patients at a frequency of 2% or greater across all clozapine studies (excluding the 2-year InterSePT™ Study). These rates are not adjusted for duration of exposure.

Table 9: Adverse Reactions ( ≥ 2%) Reported in Clozapine-treated Patients (N=842) across all Clozapine Studies (excluding the 2-year InterSePT™ Study)

Body System Adverse Reaction Clozapine
N = 842
Percentage of Patients
Central Nervous System
  Drowsiness/Sedation 39
  Dizziness/Vertigo 19
  Headache 7
  Tremor 6
  Syncope 6
  Disturbed Sleep/Nightmares 4
  Restlessness 4
  Hypokinesia/Akinesia 4
  Agitation 4
  Seizures (convulsions) 3†
  Rigidity 3
  Akathisia 3
  Confusion 3
  Fatigue 2
  Insomnia 2
Cardiovascular
  Tachycardia 25†
  Hypotension 9
  Hypertension 4
Gastrointestinal
  Constipation 14
  Nausea 5
  Abdominal Discomfort/Heartburn 4
  Nausea/Vomiting 3
  Vomiting 3
  Diarrhea 2
Urogenital
  Urinary Abnormalities 2
Autonomic Nervous System
  Salivation 31
  Sweating 6
  Dry Mouth 6
  Visual Disturbances 5
Skin
  Rash 2
Hemic/Lymphatic
  Leukopenia/Decreased WBC/Neutropenia 3
Miscellaneous
  Fever  5
  Weight Gain 4
† Rate based on population of approximately 1700 exposed during premarket clinical evaluation of clozapine.

Table 10 summarizes the most commonly reported adverse reactions ( ≥ 10% of the clozapine or olanzapine group) in the InterSePT™ Study. This was an adequate and well-controlled, two-year study evaluating the efficacy of clozapine relative to olanzapine in reducing the risk of suicidal behavior in patients with schizophrenia or schizoaffective disorder. The rates are not adjusted for duration of exposure.

Table 10: Incidence of Adverse Reactions in Patients Treated with Clozapine or Olanzapine in the InterSePT™ Study ( ≥ 10% in the clozapine or olanzapine group)

Adverse Reactions Clozapine
N = 479
% Reporting
Olanzapine
N = 477
% Reporting
Salivary hypersecretion 48% 6%
Somnolence 46% 25%
Weight increased 31% 56%
Dizziness (excluding vertigo) 27% 12%
Constipation 25% 10%
Insomnia 20% 33%
Nausea 17% 10%
Vomiting 17% 9%
Dyspepsia 14% 8%

Dystonia

Class effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of clozapine. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Central Nervous System

Delirium, EEG abnormal, myoclonus, paresthesia, possible cataplexy, status epilepticus, obsessive compulsive symptoms, and post-discontinuation cholinergic rebound adverse reactions.

Cardiovascular System

Atrial or ventricular fibrillation, ventricular tachycardia, QT interval prolongation, Torsades de Pointes, myocardial infarction, cardiac arrest, and periorbital edema.

Gastrointestinal System

Acute pancreatitis, dysphagia, salivary gland swelling.

Hepatobiliary System

Cholestasis, hepatitis, jaundice, hepatotoxicity, hepatic steatosis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, liver injury (hepatic, cholestatic, and mixed), and liver failure.

Urogenital System

Acute interstitial nephritis, nocturnal enuresis, priapism, and renal failure.

Skin

Hypersensitivity reactions: photosensitivity, vasculitis, erythema multiforme, and Stevens-Johnson Syndrome.

Musculoskeletal System

Myasthenic syndrome and rhabdomyolysis.

Respiratory System

Aspiration, pleural effusion, pneumonia, lowers respiratory tract infection.

Hemic and Lymphatic System

Deep-vein thrombosis, elevated hemoglobin/hematocrit, erythrocyte sedimentation rate (ESR) increased, sepsis, thrombocytosis, and thrombocytopenia.

Vision Disorders

Narrow-angle glaucoma.

Miscellaneous

Creatine phosphokinase elevation, hyperuricemia, hyponatremia, and weight loss.

Read the entire FDA prescribing information for Fazaclo (Clozapine) »

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


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