Initiating Clozapine

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Pre Treatment Work-up

Carry out the following pre-treatment investigations before initiating clozapine. For more information see the full guideline.

Lab tests Physical tests Other
CRP Blood pressure ECG
Full blood count Pulse Smoking status
Fasting glucose Weight Bowel function
Lipids   Check exclusion criteria (SPC)
LFTs    
Troponin    
U&E    

 

Provide appropriate patient information

 

Patient Registration

Register the patient with the monitoring service using the Clozapine patient registration form.

Treatment Initiation

To initiate a patient on clozapine, it is paramount to ensure there is effective communication between all members of the healthcare team. The following is not an exhaustive list but should be done as a minimum to ensure treatment is started in a safely and timely manner:

  1. Contact Leverndale Pharmacy Department (01412116525) to confirm appropriate registration complete.
  2. Prescribe on prescription sheet appropriately e.g. "as per titration chart."
  3. Sign and date the titration form.
  4. Scan and email prescription sheet and titration form to Leverndale Pharmacy Department (leverndale.pharmacy@ggc.scot.nhs.uk).
  5. An individually labelled supply will then be sent to the ward to initiate treatment.
  6. Avoid initiating clozapine over a weekend. This ensures that adequate supplies, dose changes and monitoring can be undertaken appropriately.
  7. For further information, please see the following guideline.
Physical Monitoring During Titration

The following measurements must be taken during the initial titration of clozapine:

Day 1

  • Blood pressure (standing and lying)- pre-dose and hourly for 6 hours.
  • Pulse- pre-dose and hourly for 6 hours.
  • Temperature- pre-dose and hourly for 6 hours.

Day 2

  • Blood pressure (standing and lying)- pre-dose and 2 & 6 hours post  morning dose.
  • Pulse- pre-dose and 2 & 6 hours post  morning dose.
  • Temperature- pre-dose and 2 & 6 hours post  morning dose.
  • Check if bowels have moved. If not, assess other dietary reasons or causative medicines and prescribe laxatives if needed.

Days 3 - 15

  • Blood pressure (standing and lying)- 6 hours post  morning dose.
  • Pulse- 6 hours post  morning dose.
  • Temperature- 6 hours post  morning dose.
  • Check if bowels have moved daily.

Day 21

  • ECG

 

 

Laboratory Monitoring During First 4 Weeks

In addition to the physical monitoring undertaken during the initial titration, the following lab results must be taken:

Days 0, 7, 14, 21 and 28

  • Full blood count.
  • CRP
  • Troponin

Days 0, 28

  • Fasting glucose
Editorial Information

Last reviewed: 26 May 2020

Next review: 01 April 2023

Author(s): MHS Clozapine review group

Version: V1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke