Re: Clozapine and Sinemet

[Mike Usman <MikeUsman@xxxxxxx>]

>In a recent posting to this List, Dr. Usman
described
>Clozapine and Sinemet as a "useful combina-
tion for
> PD patients experiencing hallucinations,
etc." ...
> Can Dr. Usman or anyone else comment
more
>extensively on this medication?

Clozaril (generic - clozapine) is an atypical antipsychotic that is on the
market in the U.S. for the treatment of schizophrenia that does not respond
to standard therapies (Haldol, etc.).  Unlike most antipsychotics, it
produces little or no Parkinson-like side effects.  At the doses used to
treat schizophrenia (avg. of  200 mg per day), 1.3% of patients develop a
drop in the white blood cell count, so a weekly blood count is required and
the medication can only be dispensed one week at a time.  In Parkinson's
disease, it is used to block the hallucinogenic side effects of meds like
Sinemet at doses of 6.25 to 37.5 mg per day.  At those doses, we have never
(to the best of my knowlege) seen the effect on the white cells but we still
have to follow the same monitoring procedure.  Remember that using clozapine
for Parkinson's-related hallucinations is not an FDA-approved indication.
 Many doctors, particularly non-psychiatrists, may be uncomfortable using it.
 No large studies of this method have been done, although there are a number
of small series of cases in the literature.  (My own experience with about 15
patients is considered a large number of cases.)

A newer atypical antipsychotic on the market, risperidone, does not have the
effect on white counts, but does not appear to work as well in Parkinson's

Please see the disclaimer below.

mike

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Mahmood (Mike) A. Usman, M.D.
Director, Memory and Movement Disorder Programs
Medical College of PA & Hahnemann University, Allegheny Campus
e-mail: mikeusman@xxxxxxx  usman@xxxxxxxxxxxxxxx
Phone: (412) 330-4005   Fax: (412) 330-4089
4 Allegheny Center      Pittsburgh, PA 15212 USA
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                     IMPORTANT DISCLAIMER:
All material presented here is for information purposes only and
is not intended to represent diagnosis, prescription of medications
or treatments, nor specific prescribing recommendations.  The opinions
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represent those of any organization or other individuals.
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