THERAPY WITH CLOZAPINE

Clozapine is called an atypical neuroleptic drug. In animal models the effects differ from those of classical neuroleptics, e.g. catalepsy i s not induced. Clozapine equally blocks dopaminergic receptors of D1- and D2-type and has strong effects on 5-HT2, H-1, alpha(1)- and alpha( 2)-adrenergic as well as muscarinergic receptors. Clinical implication s of interactions with D3-, D4-, 5-HT3-, GABA- and glutamate receptors are open to discussion. Antipsychotic effects are good in schizophren ia, but also reported e.g. in L-DOPA-induced psychosis in Parkinson's disease. The development of tardive dyskinesia was not described, even under longterm treatment; some reports even postulate a positive infl uence on various dyskinetic syndromes. In patients with post-psychotic depression or prevailing negative symptoms clozapine is superior to o ther neuroleptic drugs. The same was confirmed with regard to therapy- resistant schizophrenic patients or those who developed severe motor s ide effects under classical neuroleptics. The most frequent side effec ts are sedation, hypotension, anticholinergic effects and epileptic fi ts. The occurrence of possibly fatal agranulocytosis is supposed to be more frequent than under phenothiazines.