Schizophrenia 12.5 mg once or bid on the 1st day followed by 25 mg once or bid on the 2nd day. Thereafter, may gradually increase in steps of 25-50 mg to achieve a daily dose of up to 300 mg w/in 14-21 days. Subsequent increases in steps of 50-100 mg may be made once or twice wkly; max: 900 mg daily. Maintenance: 200-450 mg daily. Total daily dose should be given in divided doses. Daily maintenance of ≤200 mg may be given as a single dose in the evening. Elderly Initially 12.5 mg on the 1st day & subsequent dose increments should be restricted to 25 mg. Patient who are re-starting treatment after an interval of >2 days 12.5 mg once or bid on the 1st day.
Hypersensitivity. Myeloproliferative disorder, uncontrolled epilepsy or history of clozapine-induced agranulocytosis or severe granulocytopenia. Severe CNS depression or comatose states from any cause. Concomitant use w/ other agents having potential to cause agranulocytosis or otherwise suppress bone marrow function.
Risk of agranulocytosis. Patients must have a baseline WBC & differential count before initiation of treatment & a WBC count every wk or the 1st 6 mth. Patients w/ history of seizures or other predisposing factors. Do not engage in any activity where sudden loss of consciousness could cause serious risk eg, operation of complex machinery, driving an automobile, swimming, climbing. Pregnancy. Women receiving treatment should not breastfeed.
MAOIs, cyproheptadine, selegiline, lithium, fenfluramine, dexfenfluramine & tramadol. May potentiate hypotensive effects of antihypertensives & the anticholinergic effect of atropine-type drugs. Possible reverse epinephrine effect in the treatment of drug-induced hypotension.
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