GP and private psychiatrist shared care clinical resources - Clozapine

GPs and private psychiatrists may prescribe clozapine in a shared care relationship with the SA Health Mental Health Services (MHS)

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.

If a person you are managing in shared care contracts COVID-19, contact the community mental health service clozapine coordinator for support and further instruction regarding additional monitoring required.

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:

Forms and protocols

Contact the clozapine coordinator, to request paper based clozapine management forms, used in SA Health.

Examples of the forms:

  • MR74D - Example Clozapine Commencement Form (PDF 693KB)
  • MR75D - Example Clozapine Investigation Review (PDF 517KB)
  • MR76D - Example Clozapine Transfer of Care (PDF 501KB)
  • MR77D - Example Clozapine Patient 4 weekly Protocol (PDF 518KB)
  • MR78D - Example Patient Protocol Recommencement (PDF 517KB)

    • GP and Private Psychiatrist Shared Care 4 weekly clozapine patient protocol

    It is an expectation that the clozapine review and physical health data, of people in a shared care arrangement, is shared with the mental health services on a regular basis, minimum three monthly. To discuss the best way to share the information contact the clozapine coordinator.

    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

    eLearning

    Clozapine education is available online through the national High Risk Medicine modules for health professionals, for GPs and people outside of SA Health.