Smoking cessation during Covid-19 pandemic

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Background

Patients prescribed clozapine may decide to try and stop smoking prompted by concerns related to the Covid-19.

Our standard guidance recommends baseline and regular clozapine plasma level assays to support such quit attempts.

However in the current crisis undertaking such frequent plasma level monitoring will be impractical.

This guidance provides a pragmatic approach to support patients who wish to stop smoking during the pandemic.

Guidance

If a patient prescribed clozapine is engaging in a managed quit attempt during the current pandemic take the following actions.

  1. Reduce their dose initially by a fifth or a quarter of their current daily dose.
  2. Monitor closely for dose related side effects e.g.
  • Increased sedation
  • Dizziness
  • Hypersalivation
  • Tachycardia
  • Postural hypotension
  • Constipation
  • Seizures

Ensure patients are advised to contact mental health services if they experience any new side effects or a worsening of existing side effects. Advise them to inform mental health services immediately if they resume smoking.

  1. If practical take a plasma level one week after the initial dose reduction.
  2. If dose related side effects are evident reduce the dose by a further fifth to a quarter.
  3. Continue to monitor for dose related side effects for one month and make additional dose reductions if necessary.
  4. Only retest the plasma level if dose related side effects are still evident

For further advice contact Leverndale Pharmacy, 01412116525.

This guidance will only apply for the duration of the Covid-19 pandemic.

Editorial Information

Last reviewed: 14 April 2020

Next review: 01 April 2021

Author(s): PMG-MH

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke