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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suffering From Schizophrenia, No Improvement In Auditory Hallucination. Prescribed Olanzapine, Clozapine. Is It Safe?

Hi, My mother is 57 years old and she is suffering from schizophrenia for last 35 years. she had been taking olanzapin 7.5 mg for last three years.because of no improvement in auditory hallucination , she has been advised by doctor to start taking clozapine along with olanzapin. doctor has advised to start clozapin from 12.5 mag and increase it to 50 mg within 2 weeks and also take olanzapine same does. another doctor has told me that olanzapine and clozapine should not be given simultaneously because of same group. I dont know what should be done. I dont know whether my doc wants to replace olan with clozapine or he wants a combination of both. My mother has started taking clozapine for last 3 days. Please advice. please advice.
Sat, 7 Jul 2012
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General & Family Physician,  's  Response
HI sumit.pbh.

THANKS FOR YOUR QUESTION.

CLOZAPINE IS A ANTIPSYCHOTICS WHICH USUALLY GIVEN TO A CASES OF RESISTANT SCHIZOPHRENIA BUT BEFORE THAT IT IS RULE THAT ATLEAST TWO ANTIPSYCHOTICS WITH ADEQUATE DOSES HAVE TO BE TAKEN BY THE PATIENT BUT I THINK IN YOUR MOTHER THAT WAS NOT BEEN DONE.BUT IF YOUR DOCTOR START CLOZAPINE THEN ITS OK.YOU SHOULD CONTINUE IT.DOSE CAN BE INCREASED UPTO 225-300 MG AND THERE IS AS SUCH NO CONTRAINDICATION OF GIVING IT WITH OLANZAPINE BUT WHAT WE PSYCHIATRIST USUALLY DO WE GRADUALLY INCREASES THE DOSES OF CLOZAPINE AND AS HALLUCINATION REDUCES WE GRADUALLY STOP THE OLANZAPINE BY TAPPERING ITS DOSES AND KEEP THE PATIENT IN ONLY CLOZAPINE.
BUT YOU PROBABLY KNOW CLOZAPINE HAS GOT A VERY BONE MARROW SUPRESSING EFFECT SO EVERY PATIENT ON CLOZAPINE SHOULD DO A BLOOD HB,WBC COUNT EVERY WEEK FOR FIRST 6 MONTHS AND THEN EVERY TWO WEEKLY STILL THE THERAPY CONTINUE.

THANKS
DR SOURAV GANGULY
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Suffering From Schizophrenia, No Improvement In Auditory Hallucination. Prescribed Olanzapine, Clozapine. Is It Safe?

HI sumit.pbh. THANKS FOR YOUR QUESTION. CLOZAPINE IS A ANTIPSYCHOTICS WHICH USUALLY GIVEN TO A CASES OF RESISTANT SCHIZOPHRENIA BUT BEFORE THAT IT IS RULE THAT ATLEAST TWO ANTIPSYCHOTICS WITH ADEQUATE DOSES HAVE TO BE TAKEN BY THE PATIENT BUT I THINK IN YOUR MOTHER THAT WAS NOT BEEN DONE.BUT IF YOUR DOCTOR START CLOZAPINE THEN ITS OK.YOU SHOULD CONTINUE IT.DOSE CAN BE INCREASED UPTO 225-300 MG AND THERE IS AS SUCH NO CONTRAINDICATION OF GIVING IT WITH OLANZAPINE BUT WHAT WE PSYCHIATRIST USUALLY DO WE GRADUALLY INCREASES THE DOSES OF CLOZAPINE AND AS HALLUCINATION REDUCES WE GRADUALLY STOP THE OLANZAPINE BY TAPPERING ITS DOSES AND KEEP THE PATIENT IN ONLY CLOZAPINE. BUT YOU PROBABLY KNOW CLOZAPINE HAS GOT A VERY BONE MARROW SUPRESSING EFFECT SO EVERY PATIENT ON CLOZAPINE SHOULD DO A BLOOD HB,WBC COUNT EVERY WEEK FOR FIRST 6 MONTHS AND THEN EVERY TWO WEEKLY STILL THE THERAPY CONTINUE. THANKS DR SOURAV GANGULY