Clozapine

Oral health effects

• Hypersalivation (sialorrhea)

  Unusually among antipsychotics, clozapine commonly causes excess salivation, especially nocturnal.

  Mechanism: Complex muscarinic (M4 agonism) and adrenergic effects.

  Clinical management: Reassure; physician may adjust therapy; relevant for procedures requiring a dry field.

• Agranulocytosis risk (infection/ulceration)

  Clozapine can cause agranulocytosis; oral ulceration or infection may be a presenting sign.

  Clinical management: Investigate unexplained oral ulceration/infection; coordinate urgently with the prescriber (monitored blood counts).

• Dizziness on standing (orthostatic hypotension)

  Orthostatic hypotension, bradycardia and syncope are a boxed warning, with highest risk during initial titration or rapid dose increases.

  Clinical management: Raise the chair slowly at the end of the appointment and have the patient sit upright for a minute or two before standing; steady them as they get up. Ask about dizziness on standing, especially after dose changes or in older patients. Be especially cautious in the first weeks of treatment or after dose increases.