Sedation side effect of clozapine

A very common side effect of clozapine is sedation or drowsiness. This occurs in most patients when they are new to clozapine as they titrate the dosage up. Sedation is not always a problem, since early in treatment with clozapine, people are often agitated or psychotic, and sedation can be calming. Similarly, after people are improving, bedtime sedation can be desirable. After a patient is improving clinically, typically at 200 or 300 mg per day, the full dosage is often moved to bedtime, moving sedation to nighttime. With this, people may sleep longer than usual, or have morning drowsiness. Morning drowsiness can be helped by coffee or other caffeine in the morning, and getting used to being active. Note that caffeine can raise clozapine blood levels. Sedation decreases substantially over time at a given dosage. Patients should not drive or engage in potentially dangerous activities while starting clozapine until it is clear that sedation is no longer an issue. If sedation is greater than expected, the possibility of drug-drug interactions should be considered, and a clozapine plasma level can be helpful. Adding stimulant medications is often not helpful, and can result in additional side effects.

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