q508

[Anonymous]

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Which of the following adverse effects occurs most frequently during Tx with clozapine?

A:seizure
B:renal failure
C:agranulocytosis
Digmentary retinopathy
E:anticholinergic delirium

[Anonymous]

A:seizure

the incidence of seizure with a daily dosage of clozapine greater than 600mg is more than 5%.Agranulocytosis incidence is 1%

[stergs]

Is that a valid answer? I am not doubting it but I can't find literature to support it. What is the source of these questions? Thanks in advance.

[Anonymous]

These questions and answers come from various sources and are compiled from whichever subject I happen to be studying at the time. I can't find the exact source of this question, but I will provide others that state similar things.

The package insert reports 3% seizures and 1% agranulocytosis.
http://www.clozapineregistry.com/pdf/insert.pdf

http://www.mentalhealth.com/drug/p30-c02.html#Head_6
This site states 4% for seizures and 1% for agranulocytosis.

Table I

Percent of Patients Reporting Adverse Reactions (>=1%)
During Clozaril Therapy (N=842)

Organ System Adverse Reaction

CNS Drowsiness 39
Dizziness 19
Headache 7
Tremor 6
Syncope 6
Agitation 4
Restlessness 4
Hypokinesia 4
Disturbed Sleep 4
Seizures 4*
Akathisia 3
Confusion 3
Rigidity 3
Fatigue 2
Insomnia 2
Hyperkinesia 1
Weakness 1
Lethargy 1

Autonomic Nervous
System Hypersalivation 31
Hyperhidrosis
(Sweating) 6
Dry Mouth 6
Visual Disturbance 5

Cardiovascular Tachycardia 25*
Hypotension 9
Hypertension 4
Chest Pain (Angina) 1
ECG Changes 1

Gastrointestinal Constipation 14
Nausea 5
Abdominal Discomfort 4
Nausea/Vomiting 3
Vomiting 3
Diarrhea 2
Liver Test Abnormality 1

Urogenital Urinary Abnormalities 2
Urinary Urgency/Frequency 1
Urinary Incontinence 1

Respiratory Nasal Congestion 1
Throat Discomfort 1

Integumentary (Skin) Rash 2

Musculoskeletal Muscle Weakness 1

Hemic/Lymphatic Decreased WBC 3
Agranulocytosis 1*

Miscellaneous Fever (Pyrexia) 5
Weight Gain 4**

---------------------------------------------------------------
* Rate based on population of approximately 1700 exposed
during the premarket clinical evaluation of Clozaril.
**Recently published literature suggests that the incidence
of weight gain may be higher than 4%.

I can probably find more sources or even the exact source of this question if you want, but throughout my research, I have consistently found that seizures are a more common adverse effect than agranulocytosis, especially at higher doses. Agraulocytosis happens to be more unique to clozapine, and we're always told to get weekly CBCs, so that's probably why everyone focuses on it for the exam.

[stergs]

Thanks for the detailed answer. Keep up the good work.