Treatment resistant schizophrenia (TRS) explained
Weight gain with clozapine
Patients taking clozapine may experience weight gain. Weight gain is a common side-effect seen in most drugs that treat schizophrenia. Please talk to your doctor, pharmacist or nurse if weight gain begins to be an issue.
In addition to discussing any weight gain while on clozapine with your healthcare professional, the National Health Service has devised a weight loss plan that will help you lose weight in a safe manner - and keep it off.8
The NHS Choices weight loss keys to success are:
Make realistic changes to your diet and physical activity that can become a part of your regular routine
The best way to lose weight is to make long-term changes to diet and physical activity that result in a steady rate of weight loss
Aim to lose weight at around 0.5kg to 1kg a week (1lb to 2lb), until you achieve a healthy body mass index (BMI)
Tips for losing weight include:8
Don’t skip breakfast
Eat regular meals
Eat plenty of fruit and veg
Get more active
Drink plenty of water
Eat high-fibre foods
Use a smaller plate
Cut down on alcohol
Clozapine and constipation
Constipation may occur in patients taking drugs for schizophrenia, including clozapine.
Everyone has their own normal bowel habit, and this will differ from person to person. Symptoms of constipation include9:
Passing fewer stools than is normal for you
Dry, hard and lumpy, or unusually large stools that are difficult to pass
Bloating, stomach pain, and cramps
Generally, a few simple changes to your lifestyle and diet will relieve your constipation. However, you should talk to your doctor, pharmacist, or nurse if constipation becomes an issue.
Tips to help with your constipation include10:
Drink plenty of fluids
Try to cut down on caffeine and fizzy drinks
Add more fibre to your diet:
Potatoes with their skins on
Fruit and vegetables
Nuts, seeds, and oats
Become more active:
Have a daily walk
Take up cycling
Join a fitness or dance class
Try not to ignore a need to go to the toilet, as doing so can increase the likelihood of your becoming constipated. Try to establish a regular toilet routine so that you become used to going to the toilet at a specific time, e.g. first thing in the morning.
For more help and advice on constipation and how to manage it, visit the NHS Choices: Live Well - Digestive health page.
It is important that the patient’s blood is monitored for abnormalities while receiving clozapine therapy?
Blood monitoring will help the doctor detect and quickly treat any blood related side-effects if they occur.
Viatris is the name of the drug company that markets Clozaril® (clozapine). Viatris supports patients and their healthcare professionals through Clozaril® Connect, a programme to help diagnose, treat, and manage patients with TRS who benefit from clozapine.
The role of the Clozaril® Patient Monitoring Service (CPMS) is key for keeping patients safe from side effects such as blood cell abnormalities whilst taking clozapine.
- Kane J, Marder S, Schooler N, Wirshing W, Umbricht D, Baker R, et al. Clozapine and haloperidol in moderately refractory schizophrenia: a 6-month randomized double-blind comparison. Arch Gen Psychiatry 2001; 58: 965-72.
- Azorin JM, Spiegel R, Remington G, Vanelle JM, Péré JJ, Giguere M, et al. A double-blind comparative study of clozapine and risperidone in the management of severe chronic schizophrenia. Am J Psychiatry 2001; 158(8): 1305-13.
- Chakos M, Lieberman J, Hoffman E, Bradford D, Sheitman B. Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158(4): 518-26.
- Wahlbeck K, Cheine M, Essali A, Adams C. Evidence of clozapine’s effectiveness in schizophrenia: a systematic review and meta-analysis of randomized trials. Am J Psychiatry 1999; 156(7): 990-9.
- Essali A, Al-Haj Haasan N, Li C, Rathbone J. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database Syst Rev. 2009 Jan 21; (1): CD000059.
- Buchanan RW, Breier A, Kirkpatrick B, Ball P, Carpenter WT. Positive and negative symptom response to clozapine in schizophrenic patients with and without the deficit syndrome. Am J Psychiatry 1998; 155(6): 751-60.
- Clozaril® Summary of Product Characteristics (SmPC). Available at: https://www.medicines.org.uk/emc/medicine/32564 (accessed March 2018).
- NHS Choices:Live well-Healthy weight. Available at: https://www.nhs.uk/live-well/healthy-weight/ (Last accessed March 2021)
- NHS: conditions-constipation. Available at: https://www.nhs.uk/conditions/constipation/(Last accessed March 2021)
- NHS Choices: Live Well - Digestive health page https://www.nhs.uk/live-well/eat-well/good-foods-to-help-your-digestion/ (Last accessed March 2021)