>In a recent posting to this List, Dr. Usman described >Clozapine and Sinemet as a "useful combina- tion for > PD patients experiencing hallucinations, etc." ... > Can Dr. Usman or anyone else comment more >extensively on this medication? Clozaril (generic - clozapine) is an atypical antipsychotic that is on the market in the U.S. for the treatment of schizophrenia that does not respond to standard therapies (Haldol, etc.). Unlike most antipsychotics, it produces little or no Parkinson-like side effects. At the doses used to treat schizophrenia (avg. of 200 mg per day), 1.3% of patients develop a drop in the white blood cell count, so a weekly blood count is required and the medication can only be dispensed one week at a time. In Parkinson's disease, it is used to block the hallucinogenic side effects of meds like Sinemet at doses of 6.25 to 37.5 mg per day. At those doses, we have never (to the best of my knowlege) seen the effect on the white cells but we still have to follow the same monitoring procedure. Remember that using clozapine for Parkinson's-related hallucinations is not an FDA-approved indication. Many doctors, particularly non-psychiatrists, may be uncomfortable using it. No large studies of this method have been done, although there are a number of small series of cases in the literature. (My own experience with about 15 patients is considered a large number of cases.) A newer atypical antipsychotic on the market, risperidone, does not have the effect on white counts, but does not appear to work as well in Parkinson's Please see the disclaimer below. mike ----------------------------------------------------------------- Mahmood (Mike) A. Usman, M.D. Director, Memory and Movement Disorder Programs Medical College of PA & Hahnemann University, Allegheny Campus e-mail: [log in to unmask] [log in to unmask] Phone: (412) 330-4005 Fax: (412) 330-4089 4 Allegheny Center Pittsburgh, PA 15212 USA -------------------------------------------------------------- ==================================================================== IMPORTANT DISCLAIMER: All material presented here is for information purposes only and is not intended to represent diagnosis, prescription of medications or treatments, nor specific prescribing recommendations. The opinions expressed here are those of the author alone and are not intended to represent those of any organization or other individuals. ====================================================================