Posts Tagged ‘clozapine’

A suicidal vet – and what I recommended

August 19th, 2010

Our residents and students just presented a patient to me at an inpatient case conference. The man was a veteran in his mid-50s, admitted after a very serious suicide attempt. This was the latest in a series of high-lethality attempts, which have left him seriously scarred. He became psychotic in his early 20s during military service, and over the decades since has had marginal function. He carries the diagnosis of schizoaffective disorder, which his history and my interview supported.

He has taken a raft of antipsychotic medicines—almost all available. He has also taken a host of antidepressants. Conspicuous by its absence was clozapine, which I recommended. Clozapine is unquestionably the best among antipsychotics, and evidence suggests it can attenuate suicidal impulses better than any other in the class. It’s a classic “double-edged sword,” with serious adverse effects and toxicity. But his risks from those is proportionally much less than the very high likelihood he will end his life in the near future.

A reader suggestion: Eye Drops Sublingually

August 5th, 2010

In your March, 2010 issue of BTP, I wrote an article on clozapine induced hypersalivation. In it I mentioned oral anticholinergics or alphaadrenergics as potential remedies.

Reader Dr. Jaymie Shanker writes of her solution for this problem: 1% Atropine eye drops sublingually. Dr. Shanker shares:
“I start with one drop SL before bed. For some people, that is all they need. Other people need 24 drop SL qhs; some, in addition to their one drop SL qhs, put one drop into a small amount of water next to the bed, so if they wake at night drooling, they can drink that water and control the drooling for the remainder of the night. Most people don’t need it during the day, but some do use one or a few drops SL in the morning as well. The only side effect is dry mouth, if too much is used. No systemic side effects! People love it! They feel so much better getting off their oral, systemic anticholingic…Of course, it ALWAYS prompts a call from the pharmacy before the first Rx is filled, because giving an eye drop sublingually is pretty unusual.”
I thank Dr. Shanker for sharing her experience.