Clozapine Mechanism precautions side effects & uses, let us discuss Claudiapine. What is this drug? Claudia Pine claudiapine is one of the antipsychotic indicated for the treatment of schizophrenia. Among the antipsychotics, Claudiapine is having so many advantages.
This drug is an atypical agent and structurally clojapine is a dibengo dijipine. Normally, typical antipsychotics are phenotygen derivatives. But Claudiapine is a atypical agent with different chemical structure. It is a dibengo dizipine derivative. Because of the structural modification.
This drug acts as a atypical agent and closipine can act on the multiple targets. It can bind to dopamine D one receptors. It can also bind to D two receptors and D four receptors. Apart from the dopamine receptors, clausapine can also block Phihist two A receptors. By all of these actions, it can produce an efficient antipsychotic action.
Apart from this multiple mechanism action, clausapine is also one of the drug which is indicated for the treatment of resistant schizophrenia. So this drug can reduce the hospitalization and it can be used for long term where the number of attacks can be reduced by use of closapine. So among the atypical antipsychotics, clausapine can reduce a resistant psychosis. At the same time, this drug causes less extraperinal side effects. This EPS is commonly observed with typical antipsychotics.
But still, atypical antipsychotics can also produce the EPS. Among the extraperminal side effects, tardo Dyskinesia is one of the important effect which produce some reversible muscle spasm and involuntary movements. But with clausapine, we can observe less pronounced tardo dyskinesia. Therefore, this drug can be used for long term without producing significant extraterminal side effects. Another important advantage of closapine is that this drug can relieve both positive as well as negative symptoms.
So negative symptoms such as lack of emotions, blunted effect, social withdrawal, apathy, lack of initiation these symptoms can be improved with the use of Clausapine because this drug can reduce both positive symptoms as well as negative symptoms of psychosis. So these are the various advantages of closapine.
But still, this drug is not widely used because it is having few of the limitations. Even this drug produced less extraterminal side effects. Still, closapine produce a number of side effects which reduce the patient compliance and sometimes before the administration of Claudiopine, few of the tests like full blood count should be done in order to assess ANC absolute neutrophil count and WBC count.
So blood Dyscracias is one of the important limitation of closure pine which should be closely monitored on long term use of this drug. Today, we are going to see what are the important precautions, side effects, how this drug acts and what is the doses. All these things we will discuss in this video. If you like this video, please subscribe to our channel and support our work by sharing this video with your friends and click the like button and your comments are highly welcome. So let us start with the chemical nature of this closure.
Pine so this is a structure of closure pine which is a dibengo dijipine. So we can start the numbering such that nitrogen is getting the least numbers. We can give the numbering like this this is 1234-5678 910 eleven nitrogens are present at fifth and 11th portion and this is the dibengo dijipine otherwise it is a benjodine fused with a benjo ring. So we can write this as benjo benjodine and its angle saturation at the 11th portion. So eleven h third portion chlorine is there three chloro, 6th portion piper gen ring is attached by first portion so six dash piperine, one isle and to this piper gen ring at the fourth portion methyl group is present.
So four methyl, that is a complete name of closure pine. Now let us the precautions of this drug before prescribe the closure pine. Blood test should be done in order to assess absolute neutrophil count ANC as well as WBC count. These two counts should be done before administration of closure pine and the normal range of these counts. For ANC they range from 2000 to 6000 cells per microliter and for WBC it may variable around 4000 to 11,000 cells per microliter.
So these are the normal values of ANC and WBC in healthy people. So these counts should be checked in the patients before administration of closapine. But after use of closure pine the patient may have few of the symptoms such as development of fever, sore throat, unexpected weakness, shields if these symptoms are observed then immediately blood test should be done and sometimes ANC levels may fall less than 500 per microliter and WBC count may fall less than 2000 cells per microliter. In such conditions, immediately the drug should be stopped because this condition indicates the development of agranulocytosis. So closipine may cause a granulocytosis resulting in neutropenia and leukopenia.
In such conditions this drug should be immediately stopped. Even this drug should be carefully given in the patients with history of aggrangulocytosis where the ANC levels are less than 500 cells per microliter or in those patients with eukopenia where ANC is less than thousand cells per microliter or granulocytopenia where WBC count is less than 2000 cells per microliter. In all these conditions closapine should not be used and it should be immediately stopped in order to prevent further development of aggranulocytosis and possible infections in the patients. Similarly, clausapine can produce few other symptoms such as autostatic, hypertension, brady, cardia syncope particularly at very high dose. It can also produce some cardiac arrest.
That’s why closapine should be initiated at very low dose and it should be started at 12.5 mg and the dose of the drug should be slowly titrated in order to prevent any sudden damage to the cardiac system. Similarly, this drug can produce some metabolic changes resulting in hyperglycemia, increased glucose levels, and it can also increase the weight gain, and even it can increase the cholesterol levels. Particularly.
These metabolic changes are observed after six weeks of treatment with closure pine, and with use of closure pine, the patients may develop some chest pain, tachycardia, increased heart rate, palpitations, awareness of heartbeat, dyspnea, difficulty in breathing. If any of these symptoms are observed, then there may be a chance of development of cardiac disorders such as myocarditis or cardiac myopathy.
In such conditions this drug should not be used. And even this drug may increase the QT intervals, which is more important when this drug is coadministered with other drugs which again increase QT interval, normally, with the use of closapine, the QTc interval may be increased greater than 500 milliseconds. In such conditions, this drug should not be used as it lead to fatal cardiac arrhythmias. Similarly, this drug can produce one of the condition neuroleptic malignant syndrome, that is commonly observed with many of the antipsychotics. So this drug may prescribe few of the symptoms such as hyperthermia, increased body temperature, muscle rigidity, tachycardia, increased heart rate and confusion in the patients.
Another important precaution is that clausapine can also produce stardude Dyskinesia, which is a irreversible muscle spasm. Even it is somewhat less pronounced compared with typical antipsychotics. But still, closapine can induce the tardo dyskinesia. So any development of involuntary movements and muscle spasms should be thoroughly checked. With the use of closapine, particularly on long term, this drug can affect the CNS and it can increase the cerebrovascular diseases and even it may perspirate stroke and dementia.
So in the elders, this drug should be carefully used. Now let’s see how this drug acts. On the mesolympic pathway, dopaminergic neurons are present. And on the postsynaptic neurons, dopamine receptors like D two are present. On the presynaptic neuroteminals calcium channels as well as Phi T two A receptors are present.
These Phi St two A receptors are inhibitory in nature. They decrease the release of DOP mine. Now, when action potential reaches to the presynaptic neuroteminal, calcium can enter, which results in the release of dopamine. And dopamine can act on D two receptors resulting in the activation of postsynaptic receptors decrease in the cyclic Amp levels. When the cyclic Amp levels are decreased, it results in the development of positive symptoms such as hallucinations dilutions in the patients.
