Orthostatic hypotension, bradycardia, and syncope side effects of clozapine

Orthostatic hypotension is a drop in blood pressure when changing from lying or sitting to standing. This could lead to falls upon standing. Bradycardia is slowing of pulse. These can be side effects of clozapine, as can syncope (fainting). Risk is highest during early clozapine medication titration, and with more rapid dose increases. These are dose-related, though can occur at any dose. Patients can address symptoms by sitting on the edge of the bed for a minute before standing up, and otherwise moving slowly from lying or sitting to standing. Interventions for these side effects include dividing the clozapine dose throughout the day, and slowing dose titration. Increasing fluid and salt intake, or pharmacotherapy using fludrocortisone have also been used.

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