A comparison of rate control and rhythm control in patients with atrial fibrillation. However, myocarditis and cardiomyopathy can occur at any period during treatment with Clozaril. Because of the risks of severe neutropenia and of seizure associated with its use, Clozaril should be used only in patients who have failed to respond adequately to standard antipsychotic treatment The effectiveness of Clozaril in treatment-resistant schizophrenia was demonstrated in a 6-week, randomized, double-blind, active-controlled study comparing Clozaril and chlorpromazine in patients who had failed other antipsychotics Clozaril 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. Hemodynamic and surface electrocardiographic effects of a new aqueous formulation of intravenous amiodarone. Practical guidelines for clinicians who treat patients with amiodarone. Initiate treatment with a low dose (12.5 mg), titrate slowly, and use divided dosing.Use caution when administering Clozaril to patients with a history of seizures or other predisposing risk factors for seizure (e.g., head trauma or other CNS pathology, use of medications that lower the seizure threshold, or alcohol abuse).
The mean change in total BPRS score was -16 and -5 in the Clozaril and chlorpromazine group, respectively; the mean change in the 4 key BPRS item scores was -5 and -2 in the Clozaril and chlorpromazine group, respectively; and the mean change in CGI-S score was -1.2 and -0.4, in the Clozaril and chlorpromazine group, respectively. Clinical experience suggests that the prevalence of tardive dyskinesia appears to be highest among the elderly; especially elderly women Dose reduction may be necessary in patients with significant impairment of renal or hepatic function. The mechanism by which Clozaril causes neutropenia is unknown and is not dose-dependent.Two separate management algorithms are provided below, the first for patients in the general population, and the second for patients identified to have baseline neutropenia.Obtain a CBC, including the ANC value, prior to initiating treatment with Clozaril to ensure the presence of a normal baseline neutrophil count (equal to or greater than 1500/µL) and to permit later comparisons. Clozaril is indicated for the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.In the Advanced Cardiac Life Support (ACLS) guidelines published in 2000, amiodarone and procainamide are recommended for the initial treatment of hemodynamically stable wide-complex tachycardia.Typical amiodarone dosages in the ACLS setting are provided in 150-mg IV bolus over 10 minutes (if necessary, bolus may be repeated in 10 to 30 minutes); then 1 mg per minute for 6 hours; then 0.5 mg per minute for 18 hours; then reduce IV dosage or convert to oral dosing when possible.800 to 1,600 mg per day in divided doses until a total of 10 g has been given; then 200 to 400 mg per day.Bradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointes600 to 800 mg per day in divided doses until a total of 10 g has been given (may use higher initial dosage or IV dosing in unstable inpatients); then 200 mg per dayBradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointes150-mg IV bolus over 10 minutes (if necessary, bolus may be repeated in 10 to 30 minutes); then 1 mg per minute for 6 hours; then 0.5 mg per minute for 18 hours; then reduce IV dosage or convert to oral dosing when possible.800 to 1,600 mg per day in divided doses until a total of 10 g has been given; then 200 to 400 mg per day.Bradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointes600 to 800 mg per day in divided doses until a total of 10 g has been given (may use higher initial dosage or IV dosing in unstable inpatients); then 200 mg per dayBradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointesIntravenously administered amiodarone is being used with increasing frequency in the acute treatment of atrial fibrillation. High-resolution computed tomographic scanning can be helpful in making a diagnosis.The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. American College of Cardiology/American Heart Association [Published erratum appears in J Am Coll Cardiol 1999; 34:1850].