Why is clozapine a last resort?

Clozapine has unique and powerful side effects and risks, which often make it a drug of last resort.

What do you monitor clozapine with?

Monitoring clozapine patients Baseline blood tests should check white cell count, troponins, CRP and possibly BNP3. Patients with a history of cardiac disease or abnormal cardiac findings on examination (such as QT prolongation) should be referred to a cardiologist7.

What is a normal clozapine level?

Levels of around 0.6-0.8 mg/L have been proposed as the upper therapeutic limit. There is a clearer link between seizures and plasma levels over 1.0 mg/L and other types of toxicity with levels over 0.75 mg/L. For levels >1mg/L, consider cautious dose reduction and LFT (Liver Function Test) measurement.

Can clozapine be dispensed for a 90 day supply?

In a recent international consensus statement, recommendations were made to consider a reduced hematologic monitoring frequentcy of every 3 months with the dispensing of a 90 day clozapine supply (if safe).

What happens if clozapine level is too high?

If a clozapine level is unexpectedly high, evaluate the patient for dose-related side effects. If there is clozapine toxicity, the patient should obtain urgent care that includes symptomatic treatment and assessment for serious problems such as cardiac arrhythmias, seizure activity, or systemic infection.

Can clozapine be taken long term?

The results suggest that although long-term clozapine usage may increase the risk of developing cardiovascular disease, that risk may be outweighed by the reduced likelihood that those taking it will die by suicide.

What does clozapine do to brain?

Clozapine is an antipsychotic medicine that helps to adjust the levels of dopamine and other chemicals available in your brain. Clozapine reduces dopamine activity where it is too high, helping with symptoms like hallucinations.

Does clozapine require blood monitoring?

In the United States, the Food and Drug Administration requires regular blood count monitoring of all patients taking clozapine. An uncommon but serious side effect of clozapine is severe neutropenia, defined as an absolute neutrophil count (ANC) less than 500/μL.

What are the restrictions for dispensing clozapine?

Treatment should not be initiated if WBC < 3.5 k/µL. Clozapine cannot be dispensed if the WBC < 3 k/µL or if the ANC < 0.5 k/µL. 9. It is preferred that the WBC / ANC be entered on-line by the physician or a member of the clinical team.

Can a patient be restarted on a different brand of clozapine?

If a patient is found to be non-rechallengable, they must not be restarted on any brand of clozapine. Please note that the three different brands of clozapine are not interchangeable.

How can we improve the use of clozapine?

A structured approach to clozapine monitoring may improve the confidence of the clinicians leading to increase in the use of this effective but highly underutilised medication. In this regard, a specifically dedicated clozapine clinic may be helpful.

Does clozapine induce QEEG changes in schizophrenic patients?

Gross A, Joutsiniemi SL, Rimon R, Appelberg B. Clozapine-induced QEEG changes correlate with clinical response in schizophrenic patients: a prospective, longitudinal study. Pharmacopsychiatry. 2004;37:119–122. doi: 10.1055/s-2004-818989.

Is there a monitoring service for clozapine?

CLOZAPINE MONITORING Monitoring for the haematological side effects of clozapine is carried out mandatorily in a few countries; whereas the information from many countries is not available. It has been reported that without a monitoring service mortality rate from agranulocytosis increases.