Information about the Metabolic Health Initiative for clinicians, including resources to help support the physical health of mental health service consumers.
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:
- Clozapine Cardiac Guidelines (PDF 107KB) - provides management instruction for raised cardiac assays.
- Psychotropic Induced Constipation Guideline (PDF 106KB) - provides a suggested constipation management protocol.
- Adolescent Positive Cardiometabolic Health Algorithm (PDF 1.4MB) - provide advice on interventions following metabolic health screening
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Positive Cardiometabolic Health Algorithm (PDF 1.4MB) - provide advice on interventions following metabolic health screening
- Metformin - prescribing in adults guideline (PDF 113B) - provides information for the introduction of Metformin into the medication regimen to help in the reduction of obesity and weight gain in people
- Tobacco Treatment Framework (PDF 136KB) – provides an intervention framework for people prescribed psychotropic medication.
Important drug interaction information
The information below relates to clozapine drug interactions and toxicity:
- Clozapine Toxicity and Therapeutic Drug Monitoring Fact Sheet (PDF 135KB)
- Off label use Atropine Eye Drops Fact sheet (PDF 252KB)
- Factors influencing Clozapine plasma concentrations (PDF 528KB)
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.
- Psychotropic Induced Constipation Guideline (PDF 106KB)
- Psychotropic Induced Constipation Guideline Consumer Sheet (PDF 167KB)
- Choice and Medication - Clozapine and Constipation Fact Sheet (PDF 161KB)
- NPS Medicinewise Article - NHMRC Guidelines - Managing Constipation in Adults
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.
- Clozapine Strategic Management Group: Clozapine and COVID-19 Vaccination (PDF 88KB)
- Management of people, COVID-19 positive, prescribed Clozapine (PDF 243 KB)
- Antiviral treatments for mild COVID-19 disease, including people prescribed clozapine (PDF 168KB)
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:
- Green - Shared Care Arrangements Clozapine Pathways (PDF 110KB)
- Amber - Shared Care Arrangements - Clozapine Pathways (PDF 102KB))
- Red - Shared Care Arrangements Clozapine Pathways (PDF 102KB)
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:
- clinic consumer questionnaire (PDF 42KB)
- consumer information brochure (PDF 433KB)
- Clozapine information for carers and support persons (PDF 305KB)
- Clozapine care card template (PDF 232KB)
- Clozapine consumer body temperature information template (PDF 402KB)
Forms and protocols
Contact the clozapine coordinator, to request paper based clozapine management forms, used in SA Health.
Examples of the forms:
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:
Download RTF templates
Once downloaded, do not open the rtf. file as the embedded links will break.
- Best Practice - 4 weekly clozapine patient protocol (RTF 194KB)
- Medical Director - 4 weekly clozapine patient protocol (RTF 125KB)
- Zedmed - 4 weekly clozapine patient protocol (RTF 177KB)
View PDF versions
To view the form contents select the PDF version:
- Best Practice - 4 weekly clozapine patient protocol (PDF 884KB)
- Medical Director - 4 weekly clozapine patient protocol (PDF 891KB)
- Zedmed - 4 weekly clozapine patient protocol (PDF 879KB)
Questionnaires and assessments
- Questions to ask at Clozapine reviews (PDF 28KB)
- Clozapine clinic consumer questionnaire (PDF 46KB)
- Clozapine consumer body temperature information template (PDF 402KB)
- Pathways and protocols for managing abnormal/adverse events (PDF 89KB)
eLearning
Clozapine education is available online through the national High Risk Medicine modules for health professionals, for GPs and people outside of SA Health.