Clozapine poisoning can present with a variety of clinical symptoms, often depending on the severity of the overdose. Common clinical manifestations include: 1. **Central Nervous System (CNS) Effects:**    - Sedation or drowsiness    - Delirium    - Agitation    - Seizures    - Coma 2. **Cardiovascular Effects:**    - Tachycardia (fast heart rate)    - Hypotension (low blood pressure)    - ECG changes, particularly prolongation of the QT interval 3. **Respiratory Effects:**    - Respiratory depression    - Aspiration pneumonia due to reduced consciousness 4. **Anticholinergic Effects:**    - Dry mouth    - Mydriasis (dilated pupils)    - Urinary retention    - Constipation 5. **Gastrointestinal Effects:**    - Nausea and vomiting **Management of Clozapine Poisoning:** 1. **Initial Assessment and Stabilization:**    - Ensure airway, breathing, and circulation (ABCs) are intact.    - Administer oxygen and support ventilation if necessary.    - Establish intravenous (IV) access for fluids and medications.    - Monitor vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation. 2. **Decontamination:**    - Activated charcoal may be administered if the patient presents within 1 hour of ingestion and is conscious with an intact airway. It helps to reduce further absorption of clozapine from the gastrointestinal tract. 3. **Symptomatic and Supportive Care:**    - **Sedation:** Benzodiazepines may be used to manage agitation or seizures.    - **Cardiovascular Support:** IV fluids and vasopressors may be needed for hypotension. Continuous cardiac monitoring is recommended to watch for arrhythmias.    - **Anticholinergic Symptoms:** Supportive care is usually sufficient. However, physostigmine may be used in severe cases but should be administered with caution due to potential adverse effects. 4. **Monitoring and Follow-up:**    - Continuous cardiac monitoring and frequent reassessment of the patient’s neurological status.    - Monitor electrolytes and renal function.    - Repeated ECGs to monitor QT interval and other potential arrhythmias. 5. **Advanced Treatments:**    - In severe cases, extracorporeal methods such as hemodialysis or hemoperfusion are generally not effective due to the high volume of distribution and protein binding of clozapine. However, consultation with a poison control center or medical toxicologist is advised for further management. Patients with clozapine poisoning should be admitted to a hospital, and those with severe symptoms should be monitored in an intensive care unit (ICU). Recovery typically involves supportive care until the drug is metabolized and cleared from the system.