Re: Udate on Clozaril

["J.R. Bruman" <jrbruman@xxxxxxxxxx>]

Charlie, you probably also noticed that some researchers (Rabey, J. et al:
Neur 1995;45:432-434; Gonski et al: Lancet 1995;345:517-518) are still pushing
Clozaril as an antipsychotic in "low doses" to avoid the dangerous adverse
effect you mention. Personally, I don't think anyone who troubles to read
the package info in the PDR would opt for this drug despite its
admitted effectiveness.
Cheers, Joe



J. R. Bruman (818) 789-3694
3527 Cody Road
Sherman Oaks CA 91403


On Thu, 7 Sep 1995, Charles Meyer wrote:

> Dear Rachel,.
>
> Sorry about your dad.  There is clearly  a downside to Clozaril.  There are
> numerous side effects which may be making your dad feel physically worse and
> possibly even add to the confusion.  It does nothing for dementia-  that is
> the aspect of his problem where he is losing his memory as the result of
> loss of brain cells.  The sedation (although it likely will pass) may make
> it even harder for him to attend to the world around him and remember and
> understand what is happening to him. Also there is a 3% risk of aplastic
> anemia which if not caught early can be fatal.  It is MANDATORY in order to
> even get the drug from a pharmacy that weekly blood tests be carried out.
> There can also be other physical symptoms with the drug.
>
> So why prescribe such a risky drug?  Every other antipsychotic medication
> blocks the effect of dopamine receptors in the basal ganglia as well as the
> rest of the brain.  Clozaril has a unique effect providing much less
> blocking of these receptor sites.  The L-DOPA that we take for PD turns into
> Dopamine increasing this neurotransmitter everywhere.  It does not
> discriminate which receptor sites  are being stimulated too much and which
> are not getting enough dopamine.  The receptors (the place where the
> dopamine acts) are different in different parts of the brain. When the
> dopamine stimulation gets too strong in certain parts of the brain-
> hallucinations and delusions can occur.  And in other parts of the brain
> other problems like hypersexuality may occur.  If your father's
> hallucinations are being caused by his PD meds- which act by stimulating the
> dopamine receptors - usually nonselectively,  then there is reason to hope
> that he will improve if he is able to get past the side effects.  But,  if
> the cause is his general brain derioration, then it is much less likely to hel
 p.
>
> It certainly was worth a try.  I know Rush-Presbyterian has a large series
> of patients who they have given Clozaril to and likely any of the
> neurologists in that group would be able to make informed decisions
> regarding your dads treatment.
>
> I know it's frustrating talking to an on call MD but the option is having
> doctors who do nothing but medicine and then wind up either burning out or
> becoming so isolated from non-medical people that they lose the ability to
> empathize.
>
> I hope things go better.  It is worth a try-  but  frustrating when things
> don't go well.  Hang in there.
>
> Charlie
>
>
> >My father, who is 76 yrs old and has had PD for over 20 yrs, was displaying
> >psychotic behavior.  I heard about Clozaril on this list and several
> >people said they had good results with it.  So we asked my Dad's doctor
> >(Dr. Goetz, in Chicago) and they decided to put him in the hospital to begin
> >treatment.  My dad went on the drug last Friday and it has been terribly
> >down hill ever since.  He is more agitated, very sleepy, extremely
> >disoriented, and mumbles alot.  His sleeping pattern is all turned around
> >so he sleeps during the day and is awake at night.  Since it was a
> >holiday weekend, we could not get a doctor to look at him until Tuesday.
> >We never did get ahold of Dr. Goetz (he wouldn't return phone calls).  A
> >Neurologist who did see my Dad, decided to lessen the dosage of Clozaril
> >and to take my Dad off Parlodel.  All I know is my Dad is exhibiting
> >behavior he never has before he went on this drug.  The doctors did an
> >MRI which showed my Dad's brain had atrophied, but they said it was not
> >related to PD.  Has anyone else has such bad luck with Clozaril?  The
> >doctors are saying it affects everyone differently.
> >
> >- Rachel Balsam (rachelb@xxxxxx)
> >
> >
> ****************************************************************************
> *************************************
>  Charles T. Meyer
>  Madison, WI
>
> meyerct@xxxxxxxxxxxxxxxx
> ****************************************************************************
> ************************************
>