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Charlie, you probably also noticed that some researchers (Rabey, J. et al: Neur 1995;45:432-434; Gonski et al: Lancet 1995;345:517-518) are still pushing Clozaril as an antipsychotic in "low doses" to avoid the dangerous adverse effect you mention. Personally, I don't think anyone who troubles to read the package info in the PDR would opt for this drug despite its admitted effectiveness. Cheers, Joe J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks CA 91403 On Thu, 7 Sep 1995, Charles Meyer wrote: > Dear Rachel,. > > Sorry about your dad. There is clearly a downside to Clozaril. There are > numerous side effects which may be making your dad feel physically worse and > possibly even add to the confusion. It does nothing for dementia- that is > the aspect of his problem where he is losing his memory as the result of > loss of brain cells. The sedation (although it likely will pass) may make > it even harder for him to attend to the world around him and remember and > understand what is happening to him. Also there is a 3% risk of aplastic > anemia which if not caught early can be fatal. It is MANDATORY in order to > even get the drug from a pharmacy that weekly blood tests be carried out. > There can also be other physical symptoms with the drug. > > So why prescribe such a risky drug? Every other antipsychotic medication > blocks the effect of dopamine receptors in the basal ganglia as well as the > rest of the brain. Clozaril has a unique effect providing much less > blocking of these receptor sites. The L-DOPA that we take for PD turns into > Dopamine increasing this neurotransmitter everywhere. It does not > discriminate which receptor sites are being stimulated too much and which > are not getting enough dopamine. The receptors (the place where the > dopamine acts) are different in different parts of the brain. When the > dopamine stimulation gets too strong in certain parts of the brain- > hallucinations and delusions can occur. And in other parts of the brain > other problems like hypersexuality may occur. If your father's > hallucinations are being caused by his PD meds- which act by stimulating the > dopamine receptors - usually nonselectively, then there is reason to hope > that he will improve if he is able to get past the side effects. But, if > the cause is his general brain derioration, then it is much less likely to hel p. > > It certainly was worth a try. I know Rush-Presbyterian has a large series > of patients who they have given Clozaril to and likely any of the > neurologists in that group would be able to make informed decisions > regarding your dads treatment. > > I know it's frustrating talking to an on call MD but the option is having > doctors who do nothing but medicine and then wind up either burning out or > becoming so isolated from non-medical people that they lose the ability to > empathize. > > I hope things go better. It is worth a try- but frustrating when things > don't go well. Hang in there. > > Charlie > > > >My father, who is 76 yrs old and has had PD for over 20 yrs, was displaying > >psychotic behavior. I heard about Clozaril on this list and several > >people said they had good results with it. So we asked my Dad's doctor > >(Dr. Goetz, in Chicago) and they decided to put him in the hospital to begin > >treatment. My dad went on the drug last Friday and it has been terribly > >down hill ever since. He is more agitated, very sleepy, extremely > >disoriented, and mumbles alot. His sleeping pattern is all turned around > >so he sleeps during the day and is awake at night. Since it was a > >holiday weekend, we could not get a doctor to look at him until Tuesday. > >We never did get ahold of Dr. Goetz (he wouldn't return phone calls). A > >Neurologist who did see my Dad, decided to lessen the dosage of Clozaril > >and to take my Dad off Parlodel. All I know is my Dad is exhibiting > >behavior he never has before he went on this drug. The doctors did an > >MRI which showed my Dad's brain had atrophied, but they said it was not > >related to PD. Has anyone else has such bad luck with Clozaril? The > >doctors are saying it affects everyone differently. > > > >- Rachel Balsam ([log in to unmask]) > > > > > **************************************************************************** > ************************************* > Charles T. Meyer > Madison, WI > > [log in to unmask] > **************************************************************************** > ************************************ >