Planned withdrawal of clozapine

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Guidance

Where there is a planned intention to withdraw clozapine treatment this should be done gradually to prevent a significant risk of rebound psychosis.

The following guidance provides some principles to support the safe planned withdrawal of clozapine treatment.

  1. Discuss and agree a clear withdrawal plan with the patient, Leverndale pharmacy and multi-disciplinary team
  2. The Summary of Product Characteristics for clozapine recommends gradual withdrawal over at least 1 – 2 weeks. However that may be too rapid for some patients to tolerate. Consider the following issues:
    • What dose does the patient take and how long have they been taking that dose? The higher the dose and the longer the duration of treatment, the longer the duration any withdrawal will be
    • What is the treatment plan after clozapine? Are you switching to another antipsychotic? Contact mental health pharmacy services for advice on switching antipsychotics
    • Agree a step wise withdrawal regimen over at least two weeks but be prepared to extend the duration if necessary
    • Contact Leverndale Pharmacy to discuss the plan and put in place the necessary discontinuation prescriptions. The clozapine out-patient prescription form should be used for this purpose.
  1. Review for rapid emergence of psychotic symptoms
  2. Provide enhanced support to the patient during the withdrawal period
  3. Maintain clozapine full blood count monitoring during the withdrawal period and for 4 weeks after complete discontinuation i.e.

Blood monitoring frequency

Discontinuation blood sample schedule

Weekly

A further 4 weekly samples are required

Fortnightly

A further 2 fortnightly samples are required

4 weekly

A further sample is required 4 weeks after discontinuation

  1. Inform the clozapine patient monitoring service when discontinuation is complete
Editorial Information

Last reviewed: 08 October 2020

Next review: 01 October 2023

Author(s): Clozapine review group

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke