C

Cope-25

Rx

25 mg • Tablet

Clozapine • Doctor Tims Pharmaceuticals Ltd.

Therapeutic class: Atypical neuroleptic drugs

🌐 বাংলায় দেখুন

Available as: 25 mg

Indications & Uses

Cope-25 is indicated for:

Pharmacology

Clozapine is classified as an "atypical" antipsychotic because its profile of binding to dopamine receptors, and its effects on various dopamine-mediated behaviors, differ from those seen with other typical antipsychotic drugs. Clozapine does interfere with the binding of dopamine at the D1, D2, D3 and D5 receptors, and it has a high affinity for the D4 receptor. This evidence supports the view that Clozapine is preferentially more active at limbic than at striatal dopamine receptors, which may explain its relative freedom from extrapyramidal side effects. Clozapine also acts as an antagonist at adrenergic, cholinergic, histaminergic and serotonergic receptors.

Dosage Reference

Reference Information Only

Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.

Adults:

Schizophrenia

For adults over 16 years, the starting dose is 12.5 mg, taken once or twice on the first day. The elderly start at 12.5 mg once. On the second day, the dose goes to 25 to 50 mg (for the elderly, 25 to 37.5 mg). After that, the dose is raised gradually, provided it is well tolerated, in steps of 25 to 50 mg a day. In the elderly, the largest daily increase is 25 mg. This build-up takes 14 to 21 days, and the daily dose can reach up to 300 mg, split into divided doses with the larger share at night. Up to 200 mg a day may be taken as a single dose at bedtime. If needed, the dose can be increased further in steps of 50 to 100 mg, preferably once a week, though twice a week is also possible. The usual dose is 200 to 450 mg a day, and the maximum is 900 mg a day.

Psychosis in Parkinson's disease

For adults over 16 years, the dose is 12.5 mg at bedtime. It is then increased according to the response, in steps of 12.5 mg, up to twice a week. The usual dose range is 25 to 37.5 mg at bedtime, and the usual maximum is 50 mg a day. In exceptional cases, the dose may be raised further in steps of 12.5 mg a week, up to a maximum of 100 mg a day, taken in 1 or 2 divided doses.

Side Effects

Common side effects include mild dizziness or lightheadedness, drowsiness, mild headache, constipation, excess saliva or drooling, nausea or vomiting, and unusual weight gain. Less commonly, patients may notice abdominal discomfort, heartburn, or a dry mouth.

Cautions & Contraindications

Warnings & Precautions

Clozapine should not be stopped suddenly. It needs to be tapered off over 1 to 2 weeks. If the situation demands abrupt discontinuation (leukopenia, myocarditis, cardiomyopathy), the patient should be watched for psychosis and for cholinergic rebound, which shows as headache, nausea, vomiting and diarrhea. Elderly patients are more open to its adverse effects, including agranulocytosis, cardiovascular effects, anticholinergic effects and tardive dyskinesia. There is a significant risk of agranulocytosis, and it can be life-threatening. WBC testing should be done weekly for the first 6 months of therapy. After that, if acceptable counts are being maintained (WBC 3000/mm3, ANC 1500/mm3), the counts can be checked every other week. WBCs must also be monitored weekly for the first 4 weeks after the medicine is stopped. Take care when clozapine is given with other marrow suppressive agents. Eosinophilia has been reported with clozapine and may call for a temporary or permanent interruption of therapy. Cognitive and/or motor impairment (sedation) is common with clozapine, so tasks that need alertness, such as operating machinery or driving, may be affected. Use it with caution in patients at risk of seizures. This includes people with a history of seizures, head trauma, brain damage or alcoholism, and those taking other medicines that may lower the seizure threshold. Clozapine has been linked with a benign, self-limiting fever (below 100.4°F, usually within the first 3 weeks). It can also be linked with severe febrile reactions, including neuroleptic malignant syndrome (NMS). Its potential for extrapyramidal symptoms appears to be extremely low. It may cause anticholinergic effects, so use caution in patients with urinary retention, benign prostatic hyperplasia, narrow-angle glaucoma, xerostomia, visual problems, constipation or a history of bowel obstruction. Clozapine may cause hyperglycemia. In some cases this can be extreme and associated with ketoacidosis, hyperosmolar coma or death. Use caution in patients with diabetes or other disorders of glucose regulation, and monitor for worsening of glucose control. Caution is also needed in patients with hepatic disease or impairment, as hepatitis has been reported as a consequence of therapy. It may cause orthostatic hypotension and tachycardia. Use it with caution in patients at risk of hypotension, and in those who would tolerate transient hypotensive episodes poorly (cardiovascular disease or cerebrovascular disease). Using psychotropics and benzodiazepines together may raise the risk of severe cardiopulmonary reactions. Myocarditis, pericarditis, pericardial effusion, cardiomyopathy and CHF have also been associated with clozapine. Fatalities due to myocarditis have been reported. The risk is highest in the first month of therapy, though later cases have also been reported. Myocarditis or cardiomyopathy should be considered in patients who present with signs or symptoms of heart failure (dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema), chest pain, palpitations, new electrocardiographic abnormalities (arrhythmias, ST-T wave abnormalities) or unexplained fever. Patients with tachycardia during the first month should be closely monitored for other signs of myocarditis. Clozapine should be discontinued if myocarditis is suspected, and patients with clozapine-related myocarditis must not be rechallenged. The reported rate of cardiomyopathy in patients treated with clozapine is similar to that in the general population. Most of these patients were over 50 years of age and had been taking clozapine for more than 6 months. Clozapine should be discontinued in patients with confirmed cardiomyopathy unless the benefit clearly outweighs the risk. Rare cases of thromboembolism, including pulmonary embolism and stroke resulting in fatalities, have been associated with clozapine.

Contraindications

Severe cardiac disorders (e.g. myocarditis); renal impairment (avoid if creatinine clearance is under 10 ml/minute); history of neutropenia or agranulocytosis; bone-marrow disorders; paralytic ileus; alcoholic and other toxic psychoses; history of circulatory collapse; drug intoxication; coma or severe CNS depression; uncontrolled epilepsy; breast-feeding.

Pregnancy & Breastfeeding

Clozapine hasn't been studied thoroughly in pregnant women, though animal studies haven't pointed to any significant risk to the developing baby. If a doctor judges it necessary, it can still be used during pregnancy. As for breastfeeding, animal research shows Clozapine passes into breast milk, so mothers taking this medicine should avoid nursing their infants.

⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

Overdose

The most commonly reported signs of Clozapine overdose are altered states of consciousness (including drowsiness, delirium and coma), tachycardia, hypotension, respiratory depression or failure, and hypersalivation. Aspiration pneumonia and cardiac arrhythmias have also been reported, and seizures have occurred in a minority of cases. Fatal overdoses have been reported, generally at doses above 2500 mg. There are also reports of patients recovering from overdoses well in excess of 4 gm.

Management of Overdose

Establish and maintain an airway, and make sure the patient gets adequate oxygenation and ventilation. Activated charcoal, which may be used with sorbitol, may work as well as or better than emesis or lavage, and it should be considered in treating the overdose. Cardiac and vital signs monitoring is recommended, along with general symptomatic and supportive measures. Keep up surveillance for several days because of the risk of delayed effects.

When treating hypotension, avoid epinephrine and its derivatives. When treating cardiac arrhythmia, avoid quinidine and procainamide. There are no specific antidotes for Clozapine. Forced diuresis, dialysis, hemoperfusion and exchange transfusion are unlikely to be of benefit. In managing the overdose, the physician should consider the possibility that more than one drug is involved.

⚠️ In an emergency call 999 or go to the nearest hospital emergency department.

Storage

Store Clozapine at or below 30°C. Protect it from light, and keep it out of the reach of children.

Drug Interactions

Open checker →

Major Carbamazepine

Moderate Amisulpride

Moderate Risperidone

Moderate Phenytoin Sodium

Moderate Bleomycin Sulfate

Moderate Niraparib

Moderate Sertraline

Moderate Paroxetine

Moderate Adrenaline

Moderate Digoxin

Moderate Cimetidine

Moderate Insulin Degludec

Moderate Fluvoxamine Maleate

Moderate Propafenone Hydrochloride

Moderate Warfarin Sodium

Common questions about Cope-25 25 mg

What is Cope-25 25 mg Tablet?

Cope-25 25 mg Tablet is a medicine that contains Clozapine. It is made by Doctor Tims Pharmaceuticals Ltd. It belongs to the Atypical neuroleptic drugs group of medicines.

What is Cope-25 used for?

Cope-25 is used for: Parkinson's Disease, Schizophrenia.

What are the side effects of Cope-25?

Common side effects include mild dizziness or lightheadedness, drowsiness, mild headache, constipation, excess saliva or drooling, nausea or vomiting, and unusual weight gain. Less commonly, patients may notice abdominal discomfort, heartburn, or a dry mouth.

Can I take Cope-25 during pregnancy or while breastfeeding?

Clozapine hasn't been studied thoroughly in pregnant women, though animal studies haven't pointed to any significant risk to the developing baby. If a doctor judges it necessary, it can still be used during pregnancy. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

What happens if I take too much Cope-25?

The most commonly reported signs of Clozapine overdose are altered states of consciousness (including drowsiness, delirium and coma), tachycardia, hypotension, respiratory depression or failure, and hypersalivation. Aspiration pneumonia and cardiac arrhythmias have also been reported, and seizures have occurred in a minority of cases. In an emergency call 999 or go to the nearest hospital emergency department.

How should I store Cope-25?