Information about the Metabolic Health Initiative for clinicians, including resources to help support the physical health of mental health service consumers.
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.
The guidelines and algorithms below are part of the CMCG, individually identified for easy access and use:
The information below relates to clozapine drug interactions and toxicity:
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.
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.
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:
The brochures below provide people prescribed clozapine and their carers important information they need to know about the requirements of clozapine management:
Contact the clozapine coordinator, to request paper based clozapine management forms, used in SA Health.
Examples of the forms:
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.
To view the form contents select the PDF version:
Clozapine education is available online through the national High Risk Medicine modules for health professionals, for GPs and people outside of SA Health.