Clozapinept&famguide_odt-401117-print.indd

Now it's time for.
(Clozapine, USP Tablets and Orally Disintegrating Tablets) Patient & Family Guide to Teva Clozapine Therapy This is a very important time in your life
You and your family have been working
hard to deal with your schizophrenia,
and you've been taking medication to
help—but your schizophrenia has not
been completely under control for
some time now. With your doctor's
help you've switched medications a
couple of times, but you still haven't
experienced the additional improvement
you've been hoping for. Now it's time to
see if a different medication can help.
Clozapine may work when other medications don't
Doctors prescribe Clozapine for the treatment of severely ill patients with schizophrenia after they've tried other medications for schizophrenia and have not been helped by these medications (a condition called treatment-resistant schizophrenia).
Clozapine is indicated for the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. • Clozapine is also used for reducing the risk of suicide in patients with schizophrenia or schizoaffective disorder who have attempted suicide in the past and may be at risk of suicidal behavior again. • Clozapine was the first of a class of treatments called atypical antipsychotic agents and, over the years, studies have shown that Clozapine is an effective treatment option for some patients.
You and your doctor can decide if Clozapine is right for you.
(Clozapine, USP Tablets and Orally Disintegrating Tablets) How this guide can help
This guide is designed to help you understand your illness and learn how you can do your part to take your medication safely. Clozapine is reserved for use only by those patients whose previous medications have not provided adequate relief. Risks of Clozapine
• A possibly life-threatening blood disorder called agranulocytosis can occur - In this disorder not enough white blood cells are made, which could lead to a serious infection - That's why you'll need to get regular blood testing • Other serious side effects may occur, such as: n seizures n fainting n breathing problems n heart problems • You may experience drowsiness or drooling • Some patients gain weight or have abnormal lipids or cholesterol levels while taking Clozapine. There is also a risk of developing high blood sugar or diabetes while taking Clozapine. Your doctor will help you evaluate these risks.
You should NOT take Clozapine if you: • Have had blood problems called agranulocytosis or severe granulocytopenia after taking Clozapine. • Are allergic or had an allergic reaction (photosensitivity, vasculitis, erythema multiforme, or Stevens-Johnson syndrome) to Clozapine or any of the ingredients of Clozapine.
Let your doctor know if you or any family members have diabetes, or if you find that you areoften very thirsty, urinate very frequently, feel very hungry, blurry vision or feel weak. Clozapine is not approved for use in elderly patients with dementia-related psychosis. PLEASE SEE IMPORTANT SAFETY INFORMATION ON PAGES 7-10 AND ENCLOSED
PRESCRIBING INFORMATION, INCLUDING BOXED WARNINGS

What is schizophrenia?
Schizophrenia is a mental illness that medical researchers believe comes about when the brain develops a chemical imbalance or structural change. It can affect the way people think, their personal feelings, or even how they deal with other people. For some, schizophrenia can be disabling or even life-threatening. About 2.4 million Americans are affected by the disease. That's about 1.1% of the population age 18 and older. The illness affects equal numbers of men and women, but it typically begins earlier in men. The average onset of symptoms in men occurs in the late teens or early 20s, and in women in the 20s or 30s.
How Clozapine works
Scientists have made major breakthroughs in their understanding of the chemistry of the
brain and how medications can help rebalance that chemistry. Prior to those breakthroughs,
we had little knowledge of the role of the chemical messengers in the brain (called
neurotransmitters) that affect our moods and our thought processes. Now, based on
discoveries about the brain's use of the neurotransmitter chemical dopamine, scientists
have learned how to treat many of the disturbing manifestations of schizophrenia,
thereby enabling many previously unresponsive patients to lead more normal lives.
(See neurotransmitter illustrations on the next page.)
Common Side Effects. The most common side effects of Clozapine are feeling drowsy or
sleepy, feeling dizzy or lightheaded, headache, trembling, fast heart rate, low blood pressure,
fainting, excess salivation, sweating, dry mouth, vision changes, constipation, nausea, and
fever.Tell your doctor if you are pregnant or plan to become pregnant.
Tell your doctor right away if you experience high fever, stiff muscles, confusion, sweating, changes in your pulse, heart rate, or blood pressure; or severe constipation. PLEASE SEE IMPORTANT SAFETY INFORMATION ON PAGES 7-10 AND ENCLOSED
PRESCRIBING INFORMATION, INCLUDING BOXED WARNINGS

How Clozapine can help you
Clinical studies have proven that Clozapine therapy enables patients with schizophrenia to experience significant relief. However, please keep in mind that it may take several weeks or months for the medication to start to have its full effect. For Clozapine to help relieve your schizophrenia you'll need to take it exactly as your doctor directs. And, to get maximum benefit from Clozapine, you may have to take the medication throughout your life—just as a diabetic patient has to take insulin every day. So, please do not stop taking your medication without first talking with your doctor.
Getting the most from your treatment
To get the most from your Clozapine therapy: 1) closely follow the treatment plan prescribed by your doctor, 2) tell your doctor if you experience any side effects, such as tiredness, dizziness, neck muscle spasm, seizures, or fever, and 3) regularly come in for your Clozapine-monitoring blood tests (see page 6 for more information). Your lab tests are very important because they help your doctor identify possibly life-threatening side effects. That's also the reason why your pharmacy can't dispense your next Clozapine refill until it gets a favorable update on your blood test results.
Clozapine can cause a rapid fall in blood pressure, which makes you feel dizzy or lightheaded and can lead to fainting when you suddenly change position.
Clozapine blocks a chemical called dopamine
Artist's conception of the Clozapine (shown as orange chemical messenger dopamine spheres) is believed to relieve (shown as blue spheres) leaving symptoms of schizophrenia by one nerve cell and traveling to the temporarily occupying these adjacent nerve cell to occupy one same receptors and blocking of five possible dopamine recep- the dopamine from having its tors (D1, D2, D3, D4, or D5).
usual effect.




Your need for blood tests and monitoring
When you first start taking Clozapine, your doctor will enroll you in the Teva Clozapine Patient
Registry to help you monitor your white blood cell count (WBC) and absolute neutrophil count
(ANC). In the beginning you'll be tested every week. Then, after six months—if your blood test
results are acceptable—your doctor may decide that you need testing only every two weeks.
After another six months of acceptable test results, your doctor may decide to further
reduce your monitoring schedule to just once every four weeks.
The important work you have to do to get good results from your new medication is:
1) closely follow your doctor's instructions, 2) regularly return for your blood monitoring,
and 3) tell your doctor if you miss a dose, especially if you miss your Clozapine dose for more
than two days. If you make it a priority to follow these three steps, you'll be helping your
doctor to help you.
* with acceptable blood test results Potential Clozapine side effects you need to know about
As with any medication, Clozapine can produce unwanted side effects. Some of these side
effects disappear as you continue taking your medication and others may go away as your
doctor adjusts your dosage.
Treatment-Resistant Schizophrenia is a serious mental illness with serious symptoms, and the potent medications that are required to treat these symptoms can have significant side effects as well. As mentioned earlier, agranulocytosis is a possibly life-threatening side effect associated with Clozapine therapy and it causes a severe decrease in a patient's white blood cell count. That's why your doctor has enrolled you in a Clozapine Patient Registry, and you are required to have blood tests on a regular basis as long as you are taking this medication.
PLEASE SEE IMPORTANT SAFETY INFORMATION ON PAGES 7-10 AND ENCLOSED
PRESCRIBING INFORMATION, INCLUDING BOXED WARNINGS

Indications
Clozapine is a prescription medicine for the treatment of severely ill patients with
schizophrenia, a serious mental illness, who are not helped by other medicines for schizophrenia (treatment-resistant schizophrenia). It should be used only after at least two standard drugs for schizophrenia have either failed or caused serious side effects. Clozapine is also used for reducing the risk of suicide in patients with schizophrenia or schizoaffective disorder who have attempted suicide in the past and may be at risk of suicidal behavior again. Important Safety Information
• Agranulocytosis.
Clozapine therapy can cause a severe decrease in white blood cells,
called agranulocytosis which could lead to a serious infection and death. You should reportany signs or symptoms to your doctor that may be associated with agranulocytosis or infection such as fever; mouth sores; skin, throat, vaginal, kidney, bladder or lung infection. Because of the risk of agranulocytosis, Clozapine is available only through a restricted program called the Clozapine Patient Registry. Prescribers, patients, and pharmacies must enroll in the program. Your doctor will schedule frequent blood tests while you are taking Clozapine so that he/she can monitor and make sure you are not developing agranulocytosis. You must have your blood tested before beginning treatment with Clozapine. If your results are acceptable after weekly blood tests for the first 6 months of treatment, you may be able to have your blood tested every other week for the next 6 months. After that, testing once each month might be possible. Your doctor will determine how often you will need testing. When stopping treatment with Clozapine for any reason, blood tests will continue on a weekly basis for 4 weeks. • Orthostatic Hypotension, Bradycardia, and Syncope: Clozapine can cause your
blood pressure to drop suddenly, called orthostatic hypotension, which can make you feeldizzy or lightheaded and can lead to fainting (syncope) when you change position, such asstanding or sitting up after lying down. This can also cause you to stop breathing or yourheart to stop beating. Tell your doctor if you have heart disease or any other cardiovascularor cerebrovascular problems or are taking medicine for hypertension, or high blood pressure or have experienced dehydration. Follow your doctor's instructions for dosage and administration. Contact your doctor immediately if you feel faint, lose consciousness, or have any signs or symptoms suggestive of low heart rate or abnormal heart beat.
• Seizures. There is a high risk of having seizures during Clozapine treatment. Tell your
doctor if you have a history of seizures or are at risk for seizures. Alcohol abuse while taking Clozapine may increase the risk of seizures. You should avoid driving or doing any other dangerous activity while taking Clozapine.
• Myocarditis and Cardiomyopathy. Clozapine can cause an inflammation of the heart
muscle, known as cardiomyopathy and myocarditis, which can be life-threatening. Tell yourdoctor if you experience any chest pain, difficulty breathing, an increase in heart rate, palpitations, fever, flu-like symptoms, or low blood pressure. Patients with Clozapine-related myocarditis or cardiomyopathy should not take Clozapine again.
Important Safety Information (continued)
• Elderly patients with a mental illness called dementia-related psychosis and

who are taking antipsychotic drugs, such as Clozapine, are at a higher risk of
death. Clozapine is not approved for use in these patients.
• You should not take Clozapine if you:
n Have had blood problems called agranulocytosis or severe granulocytopenia after taking Clozapine.
n Are allergic or had an allergic reaction (photosensitivity, vasculitis, erythema multiforme, or Stevens-Johnson syndrome) to Clozapine or any of the ingredients of Clozapine. • Eosiniphilia. Clozapine treatment can cause eosinophilia, or an increase in the number of
white blood cells. This usually occurs during the first month of treatment and has been associated with inflammation of the heart, pancreas, liver, colon and kidneys. If it is suspected, Clozapine should be discontinued immediately.
• QT Prolongation. Clozapine treatment is associated with abnormal heartbeat that can
become life-threatening. Tell your doctor if you, or anyone in your family, have had any heart problems. You should not use Clozapine with other medicines that are known to cause any heart problems. Notify your doctor if you feel faint, lose consciousness or have abnormal heartbeat. • Neuroleptic Malignant Syndrome (NMS). Clozapine can cause NMS, a condition
that can be life-threatening. Tell your doctor right away if you have high fever, stiff muscles, confusion, sweating, or changes in your heart rate or blood pressure.
• Pulmonary Embolism. Pulmonary embolism (blood clot in the lungs) and deep vein
thrombosis have occurred in patients treated with Clozapine. Patients should report pain in their legs (deep vein thrombosis), shortness of breath, chest pain or other respiratory signs and symptoms to their doctor. • Anticholinergic Toxicity. Clozapine should be used with caution in patients who have
narrow-angle glaucoma, are taking other anticholinergic medications, or have enlarged prostates. Clozapine can result in gastrointestinal adverse reactions, which may be fatal, including constipation, fecal impaction, or paralytic ileus. Tell your doctor if you have ever had any eye, prostate or colon problems and about all of the medications you are taking. • Tardive Dyskinesia (TD). Clozapine can cause TD, a serious, sometimes permanent,
condition in which you have uncontrolled movements of the face or other parts of the body.
The risk for developing TD can increase over time with more medicine, but can also developwithin a short time and at low doses. There is no known treatment for TD, but it may go away partially or completely if the medicine is stopped. • Metabolic Changes (hyperglycemia and diabetes mellitus, dyslipidemia, weight gain).
Clozapine is associated with metabolic changes that require specific monitoring. The risks
include hyperglycemia and diabetes mellitus, dyslipidemia, weight gain, and cardiovascular
reactions. Clozapine can cause an increase in the amount of glucose, or sugar, in your
blood, called hyperglycemia. Your doctor may check your blood sugar level before you start
taking Clozapine and periodically during treatment. Tell your Doctor right away if you have
any of the following symptoms while taking Clozapine: you are very thirsty, urinate very often,
are very hungry, have blurry vision, or feel weak. Tell your doctor if you have diabetes or if
you are at risk for diabetes (because of obesity or because someone in your family has
diabetes). Abnormal lipids or cholesterol levels have occurred in patients treated with
Clozapine. Weight gain has also occurred with the use of Clozapine. Monitoring of weight
and cholesterol levels at baseline and during Clozapine therapy is recommended.
• Effect on Behavior and or Physical Abilities. Clozapine can affect how you think or
behave and/or your physical abilities, and may make you feel sleepy and less alert,
especially during the first few days of treatment. Do not drive or operate heavy machinery
until you know how Clozapine affects you. Ask your doctor when it would be okay to do these
activities.
• Missed Doses and Re-initiating Treatment. Tell your doctor if you miss a dose of
Clozapine for more than two days. You should not restart your medication, and contact
your doctor for dosing instructions.
• Pregnancy and Nursing. Clozapine should be used in pregnancy only if the potential
benefit is greater than the potential risk to the fetus. Tell your doctor if you are pregnant
or plan to become pregnant. You should not breastfeed while taking Clozapine.
• Use with Other Medications. Tell your doctor about all the medicines you are taking,
including over-the-counter medicines. There is a potential that the drugs could interact with
each other.
• Clozapine, USP Orally Disintegrating Tablets contain phenylalanine (a
component of aspartame).
• Common Side Effects.
The most common side effects of Clozapine are feeling drowsy or
sleepy, feeling dizzy or lightheaded, headache, trembling, fast heart rate, low blood pressure,
fainting, excess salivation, sweating, dry mouth, vision changes, constipation, nausea, and
fever.
This does not discuss all of the risks associated with Clozapine. Please see the
accompanying full Prescribing Information, including Boxed Warnings, for the complete
risks associated with Clozapine use.
If you would like more information, talk with your
doctor or pharmacist.
Important Safety Information (continued)
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit
www.fda.gov/medwatch, or call 800.FDA.1088.
Tips for Success
1. Mark your calendar so you'll remember when to take your medication,
and when to come in for your regular blood tests.
2. Follow your doctor's dosing instructions exactly.
3. Don't skip any doses—and, if you forget to take your Clozapine,
tell your doctor right away.
4. If drooling occurs, wrap a towel around your pillow at night.
5. Exercise regularly and eat right to help maintain a healthy weight.
Doing Your Part
Are you willing to do your part?
o Yes, I'm willing to follow a schedule on my calendar.
o Yes, I'm willing to have blood tests regularly.
o Yes, there are people who will help me.
Isn't Clozapine worth a little extra effort?
This booklet does not discuss all of the risks associated with Clozapine. Please see
the Important Safety Information on pages 7-10 and the enclosed full Prescribing
Information, including Boxed Warnings, for the complete risks associated with
Clozapine use.






Look inside this pocket for useful items that will help you be successful with (Clozapine, USP Tablets and Orally Disintegrating Tablets) Patient Nutrition Guide Nutrition
A handy reference card for use in recording your starting dosage schedule and other helpful information 2010, Teva Pharmaceuticals USA (Clozapine, USP Tablets and Orally Disintegrating Tablets) Wallet-sized folding calendar so you can mark the days when you need to come in for your blood tests PLEASE SEE IMPORTANT SAFETY INFORMATION ON PAGES 7-10 AND ENCLOSED
PRESCRIBING INFORMATION, INCLUDING BOXED WARNINGS

(Clozapine, USP Tablets and Orally Disintegrating Tablets) Clozapine requires a little extra effort, but it's worth it For more information and support, please consult the following resources: National Alliance on Brain and Behavior National Institute of Mental Health Mental Illness (NAMI) Research Foundation 3803 N. Fairfax Dr., Suite 100 90 Park Avenue, 16th Floor 6001 Executive Blvd., Room 6200, Arlington, VA 22203 New York, NY 10016 Phone: 703.524.7600 Phone: 800.829.8289 Bethesda, MD 20892 Fax: 703.524.9094 Phone: 301.443.4513 Help Line: 800.950.NAMI (6264) Toll Free: 866.615.6464 Email: info@nami.org TTY: 301.443.8431 Website: www.nami.org TTY Toll Free: 866.415.8051 Email: nimhinfo@nih.gov PLEASE SEE IMPORTANT SAFETY INFORMATION ON PAGES 7-10
AND ENCLOSED PRESCRIBING INFORMATION, INCLUDING BOXED WARNINGS
2014, Teva Pharmaceuticals USA ODT-40117

Source: http://www.tevaclozapine.com/documents/PatientGuide1061202_TevaCloz_Web.pdf

Using latent class analysis to model prescription medications in the measurement of falling among a community elderly population

Hardigan et al. BMC Medical Informatics and Decision Making 2013, 13:60http://www.biomedcentral.com/1472-6947/13/60 Using latent class analysis to model prescriptionmedications in the measurement of fallingamong a community elderly population Patrick C Hardigan1*†, David C Schwartz2† and William D Hardigan3† Background: Falls among the elderly are a major public health concern. Therefore, the possibility of a modelingtechnique which could better estimate fall probability is both timely and needed. Using biomedical,pharmacological and demographic variables as predictors, latent class analysis (LCA) is demonstrated as a tool forthe prediction of falls among community dwelling elderly.

residenciasmedicas.com.ar

1) Cual de los siguientes comportamientos correspondientes al desarrollo socioemocional y motor es el de un lactante entre los 3 y los 4 meses de vida? a) Se mantiene sentado sin apoyo. b) Muestra desconfianza o llanto ante los extraños. c) Detiene su accion ante el "no". d) Sostiene la cabeza. 2) Cual es el diagnostico mas probable en un lactante de 11 meses de vida, eutrofico, con oliguria de aparicion brusca, palidez y convulsion tonico-clinica generalizada de 10 minutos de duracion? a) Meningoencefalitis. b) Sindrome de Reye. c) Sepsis. d) Sindrome uremico-hemolitico. 3) En la consulta inicial una mujer de 56 años olvido informar al medico de sus antecedentes de asma. Se comenzo en fecha reciente un esquema de propranolol para tratar migrañas y ahora se presenta a la clinica con sibilancias y disnea intensas. Cual de los siguientes farmacos se le debe administrar por inhalacion? a) Hipatropio. b) Cromolin sodico. c) Albuterol. d) Beclometasona. 4) El delirium tremens es una de las manifestaciones del sindrome de abstinencia enolica que suele aparecer: a) Una semana despues de la de privacion. b) Es raro despues de pasadas las 24 horas. c) Puede ocurrir en cualquier momento despues de la de privacion. d) Generalmente se produce entre las 48 y las 72 horas desde la ultima ingesta. 5) Cual es la complicacion m s frecuente de la mononucleosis infecciosa? a) Artritis. b) Apendicitis. c) Uveitis.