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VERSACLOZ is indicated for the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. Because of the risks of severe neutropenia and of seizure associated with its use, VERSACLOZ should be used only in patients who have failed to respond adequately to standard antipsychotic treatment [see WARNINGS AND PRECAUTIONS].
The effectiveness of clozapine in treatment-resistant schizophrenia was demonstrated in a 6-week, randomized, double-blind, active-controlled study comparing clozapine and chlorpromazine in patients who had failed other antipsychotics [see Clinical Studies].
Reduction In The Risk Of Recurrent Suicidal Behavior In Schizophrenia Or Schizoaffective Disorder
VERSACLOZ is indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state. Suicidal behavior refers to actions by a patient that put him/herself at risk for death.
The effectiveness of clozapine in reducing the risk of recurrent suicidal behavior was demonstrated over a two-year treatment period in the InterSePT™ trial [see Clinical Studies].
DOSAGE AND ADMINISTRATION
Required Laboratory Testing Prior To Initiation And During Therapy
Prior to initiating treatment with VERSACLOZ, a baseline ANC must be obtained. The baseline ANC must be at least 1500/μL for the general population, and at least 1000/μL for patients with documented Benign Ethnic Neutropenia (BEN). To continue treatment, the ANC must be monitored regularly [see WARNINGS AND PRECAUTIONS].
The starting dose is 12.5 mg once daily or twice daily. The total daily dose can be increased in increments of 25 mg to 50 mg per day, if well-tolerated, to achieve a target dose of 300 mg to 450 mg per day (administered in divided doses) by the end of 2 weeks. Subsequently, the dose can be increased once weekly or twice weekly, in increments of up to 100 mg. The maximum dose is 900 mg per day. To minimize the risk of orthostatic hypotension, bradycardia, and syncope, it is necessary to use this low starting dose, gradual titration schedule, and divided dosages [see WARNINGS AND PRECAUTIONS].
Important Administration Instructions
VERSACLOZ Oral Suspension is administered to the mouth by the oral syringes provided (1 mL or 9 mL). After shaking the bottle for 10 seconds prior to each use, the syringe adaptor is pressed on top of the bottle. The oral syringe (1 mL or 9 mL) is filled with air, and inserted into the adaptor. The air is dispelled into the bottle and then the bottle is turned upside down. The prescribed amount of the suspension is drawn from the bottle and dispensed directly to the mouth. The prescribed dose should be administered immediately after it is prepared. Do not draw a dose and store it in the syringe for later use. After use, the oral syringe may be washed with warm water and dried for next use. The bottle may be closed with the same cap without removing the bottle adaptor. Educate patients and caregivers on the steps to administer VERSACLOZ as described in the Patient Instructions for Use.
VERSACLOZ can be taken with or without food [see Pharmacokinetics].
Generally, patients responding to VERSACLOZ should continue maintenance treatment on their effective dose beyond the acute episode.
Discontinuation Of Treatment
Method of treatment discontinuation will vary depending on the patient's last ANC:
- See Tables 2 or 3 for appropriate ANC monitoring based on the level of neutropenia if abrupt treatment discontinuation is necessary because of moderate to severe neutropenia.
- Reduce the dose gradually over a period of 1 to 2 weeks if termination of VERSACLOZ therapy is planned and there is no evidence of moderate to severe neutropenia.
- For abrupt clozapine discontinuation for a reason unrelated to neutropenia, continuation of the existing ANC monitoring is recommended for general population patients until their ANC is ≥ 1500/μL and for BEN patients until their ANC is ≥ 1000/μL or above their baseline.
- Additional ANC monitoring is required for any patient reporting onset of fever (temperature of 38.5°C or 101.3°F, or greater) during the 2 weeks after discontinuation [see WARNINGS AND PRECAUTIONS].
- Monitor all patients carefully for the recurrence of psychotic symptoms and symptoms related to cholinergic rebound such as profuse sweating, headache, nausea, vomiting, and diarrhea.
Re-Initiation Of Treatment
When restarting VERSACLOZ in patients who have discontinued VERSACLOZ (i.e., 2 days or more since the last dose), re-initiate with 12.5 mg once daily or twice daily. This is necessary to minimize the risk of hypotension, bradycardia, and syncope [see WARNINGS AND PRECAUTIONS]. If that dose is well tolerated, the dose may be increased to the previously therapeutic dose more quickly than recommended for initial treatment.
Dosage Adjustments With Concomitant Use Of CYP1A2, CYP2D6, CYP3A4 Inhibitors Or CYP1A2, CYP3A4 Inducers
Dose adjustments may be necessary in patients with concomitant use of: strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, or enoxacin); moderate or weak CYP1A2 inhibitors (e.g., oral contraceptives, or caffeine); CYP2D6 or CYP3A4 inhibitors (e.g., cimetidine, escitalopram, erythromycin, paroxetine, bupropion, fluoxetine, quinidine, duloxetine, terbinafine, or sertraline); CYP3A4 inducers (e.g., phenytoin, carbamazepine, St. John's wort, and rifampin); or CYP1A2 inducers (e.g., tobacco smoking) (Table 1) [see DRUG INTERACTIONS].
Table 1: Dose Adjustment in Patients Taking
|Initiating VERSACLOZ while taking a co-medication||Adding a co-medication while taking VERSACLOZ||Discontinuing a co-medication while continuing VERSACLOZ|
|Strong CYP1A2 Inhibitors||Use one third of the VERSACLOZ dose.||Increase VERSACLOZ dose based on clinical response.|
|Moderate or Weak CYP1A2 Inhibitors||Monitor for adverse reactions. Consider reducing the VERSACLOZ dose if necessary.||Monitor for lack of effectiveness. Consider increasing VERSACLOZ dose if necessary.|
|CYP2D6 or CYP3A4 Inhibitors|
|Strong CYP3A4 Inducers||Concomitant use is not recommended. However, if the inducer is necessary, it may be necessary to increase the VERSACLOZ dose. Monitor for decreased effectiveness.||Reduce VERSACLOZ dose based on clinical response.|
|Moderate or weak CYP1A2 or CYP3A4 Inducers||Monitor for decreased effectiveness. Consider increasing the VERSACLOZ dose if necessary.||Monitor for adverse reactions. Consider reducing the VERSACLOZ dose if necessary.|
Renal Or Hepatic Impairment, Or CYP2D6 Poor Metabolizers
It may be necessary to reduce the VERSACLOZ dose in patients with significant renal or hepatic impairment, or in CYP2D6 poor metabolizers [see Use in Specific Populations].
Dosage Forms And Strengths
VERSACLOZ is available as a free-flowing yellow oral suspension. Each mL contains 50 mg of clozapine.
Free-flowing, yellow suspension (50 mg/mL) in amber bottle containing 100 mL. Each box contains 1 x 1 mL oral syringe, 1 x 9 mL oral syringe and 1 bottle adaptor.
NDC No. 18860-121-01
Storage And Handling
Store VERSACLOZ at or below 25°C (77°F). Do not refrigerate or freeze. Protect from light. Shake well for 10 seconds before use.
The suspension is stable for 100 days after initial bottle opening.
Keep out of reach of children.
Distributed by: Jazz Pharmaceuticals, Inc., Palo Alto, CA 94304 USA. Revised: Sep 2015This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 5/13/2016
Additional Versacloz Information
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