Clozapine clinical resources

Information relating to all aspects of clozapine management for community clozapine coordinators, inpatient clinical staff, pharmacists, medical officers, and all other staff associated with caring for a person prescribed clozapine can be found here.

The Clozapine Management Clinical Guideline (CMCG) (PDF 3.95MB) provides all the information required to safely manage people prescribed clozapine. The CMCG provides stepped instruction for the commencement, management and when required recommencement of clozapine. For SA Health clozapine clinics and all those in shared care with an SA Health clozapine clinic, adherence to the CMCG is expected.

Guidelines and algorithms

The guidelines and algorithms below are part of the CMCG, individually identified for easy access and use:

Important drug interaction information

The information below relates to clozapine drug interactions and toxicity:

Constipation

A potential severe gastrointestinal adverse effect of clozapine treatment is clozapine induced gastrointestinal hypomotility (CIGH), commonly referred to as ‘slow gut’ which may result in severe constipation, ileus, bowel obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death.

CIGH is significantly more common than blood dyscrasias and has a reported higher mortality rate.

COVID-19

Evidence shows that COVID-19 infection can have adverse effects on Clozapine levels and white cell counts, leading to clozapine toxicity or neutropenia. SA Health have introduced COVID-19 positive guidelines to monitor people prescribed clozapine in the event of an infection. Clozapine also adversely interacts with antiviral medication, Paxlovid.

Nurse led clozapine clinics

SA Health Mental Health Services (MHS) have Nurse led clozapine clinics in metropolitan Local Health Networks (LHN), to monitor people prescribed clozapine. The resources below will assist in understanding the nurse led clinic processes, questions to be asked of people prescribed clozapine, and the management of abnormal/adverse events.

Communication pathways

Communication between services is essential for the safe management of people prescribed clozapine. The pathways below define the expected communication processes.

GP and Private Psychiatrist Shared care protocols

Shared care arrangements between MHS and general practice (GP) and/or Private Psychiatrists is a major part of clozapine management and integrating GP care into the person’s overall health and wellbeing.

The pathways below show the formalised clozapine shared care with MHS for all stages of clozapine management:

Information for people prescribed clozapine and their carers

The brochures below provide people prescribed clozapine and their carers important information they need to know about the requirements of clozapine management:

eLearning

Clozapine education is available online through:

Alert instructions and screen captures

SA Health have designated clozapine management record screens found in the Community Based Information System. People on clozapine also require alerts to be added into the OACIS and Sunrise electronic medical record systems. The information below provides instructions for completing the required alerts:

Forms and protocols

Clozapine management forms used in SA Health are available to order through Oracle for all aspects of clozapine care. Examples of the forms are below:

GP Shared Care 4 weekly clozapine patient protocol

The 4 weekly clozapine patient protocol form is available in rtf. formats for GP and private psychiatrist software.

Instructions on how to import the form into clinical management applications are available below:

  • Importing templates into Best Practice fact sheet (PDF 54KB)
  • Importing templates into Medical Director fact sheet (PDF 55KB)
  • Importing templates into Zedmed fact sheet (PDF 57KB)

    • Download RTF templates

    Once downloaded, do not open the rtf. file as the embedded links will break.

    View PDF versions

    To view the form contents select the PDF version:

    Questionnaires and assessments