Clozapine also may cause extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes). Like other anti-psychotics, clozapine also may cause tardive dyskinesia (potentially irreversible involuntary movements). The risk of such reactions appears to be lower with clozapine than with older anti-psychotics, perhaps due to its weaker effects on dopamine type 2 receptors.

Although there is no clear link between clozapine and diabetes, patients should be tested during treatment for elevated blood-sugars. Additionally, persons with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.

Clozapine is eliminated from the body by enzymes (P450) in the liver. Numerous medications can increase or decrease the activities of these enzymes leading to low (potentially ineffective) or high (potentially toxic) levels of clozapine in the blood. When used with these medications, the dose of clozapine may need to be reduced or increased.

Reference: FDA Prescribing Information

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