Initiating Clozapine

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

Provide appropriate patient information

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

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 safe and timely manner:

1. Contact Leverndale Pharmacy Department (01412116525) to confirm appropriate registration complete.
2. Prescribe on HEPMA using the pre-set protocols or ‘as charted’ for bespoke initiations
3. If using pre-set protocols, Leverndale Pharmacy should be informed that it has been prescribed either via telephone or email
4. For bespoke titrations, sign and date the titration form. This should then be scanned and emailed Leverndale Pharmacy Department
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.

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.

Day2

• 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

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