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A patient is deemed to have had a clozapine treatment break if dosing has been interrupted for more than 48 hours.
If treatment has been missed for less than 48 hours this is not classed as a treatment break and dosing may resume without any adjustment.
Clozapine monitoring service |
Treatment break rules – change of blood test frequency |
CPMS (Clozaril) |
If there has been a break of more than 96 hours, revert to weekly blood tests for 6 weeks* |
DMS (Denzapine) |
If there has been a break of more than 72 hours, revert to weekly blood tests for 6 weeks* |
ZTAS (Zaponex) |
* After 6 weeks patients may resume their previous blood sampling schedule if authorised to do so by the monitoring service.
The clinical team must notify the clozapine patient monitoring service and Leverndale pharmacy of the treatment break as soon as possible, even if clozapine treatment has been resumed already.
Please note:
Patients should recommence clozapine treatment starting from 12.5mg once or twice daily on day 1. The product information for clozapine suggests that re-titration to a previous dose may be achieved at a faster rate than initial titration, if it is safe to do so. The blank clozapine titration chart can be used for this purpose.
The following factors should be considered when deciding how quickly to build up the dose:
If in doubt use the standard clozapine titration chart . This takes the daily dose to 275mg by day 15 and further alterations can be made from there as appropriate.
Provide regular patient education emphasising the need for reliable compliance with treatment.
As admission to an acute hospital is often a source of unintended treatment breaks, ensure clozapine warnings on EMIS are up to date so that clozapine use is identified on the Glasgow Mental Health Summary within Clinical Portal.
Last reviewed: 18 August 2020
Next review: 01 August 2023
Author(s): Clozapine review group
Version: 1
Approved By: PMG-MH
Reviewer Name(s): Andrew Walker, Suzanne Burke