Clozapine

What you will learn

Clozapine is a high risk medicine used in the treatment of treatment resistant schizophrenia

This training course is designed to provide education about the use of this medicine and links to further education for clinicians who are involved in the management of Clozapine.

Relevance

This course is designed for all health professionals involved in the management of clozapine.

Learning outcomes

On completion of this course you will be able to:

  • define schizophrenia and its treatments
  • describe the role of antipsychotics in treatment
  • explain why clozapine is a high risk medicine
  • list the benefits and disadvantages of clozapine
  • identify who clozapine is suitable for
  • describe the strict pathology, cardiac and other monitoring requirements used to safely manage clozapine
  • describe the treatment models available to support the monitoring requirements
  • describe where to access more information and resources to support safe clozapine management

About this course

Target Audience

This course is intended for all healthcare staff involved in the management of high risk medicines.

Duration

The course is designed to take about an hour and a half to complete. This does not include the reading of additional or optional texts which are provided throughout.

Certificate

On successful completion of the assessments you can download a certificate of completion.

Compliance

This course aligns with the National Safety and Quality Health Service Standards, Second Edition – Standards 1, 2, 4 & 6.

Clinical Governance Standard: Ticked Partnering with Consumers Standard: Ticked Medication Safety Standard: Ticked Communication for Safety Standard: Ticked

Disclaimer

This course content was developed by the Australian Commission on Safety and Quality in Health Care and is protected by copyright under a Creative Commons Attribution-Non-Commercial-Share Alike (BY-NC-ND) 4.0 International License.

The content is provided in good faith by the Commission for information purposes. It is not a substitute for, and is not intended to replace, any specific policies, guidelines or requirements for your local health network or health service.

The Commission does not accept any legal liability or responsibility for any injury, loss or damage incurred by the use of, or reliance on, this information.

Resources

SA Health:

Government of Western Australia, Department of Health:

Queensland Government, Queensland Health:

National Impatient Medication Chart:

Clozapine in Primary Care. Aust Prescr 2017;40:231–6.

References

Australian Medicines Handbook (2017) Chapter 18: Antipsychotics/Clozapine. Australian Medicines Handbook Pty Ltd.

Schizophrenia and related psychoses in eTG: Psychotropic guidelines available via SALUS

Alawami M, Wasywich C, Cicovic A, Kenedi C. A systematic review of clozapine induced cardiomyopathy. Int J Cardiol. 2014 Sep 20;176(2):315–20.

Bleakley S, Taylor D. The Clozapine Handbook. UK: Lloyd-Reinhold Communications; 2013.

Cohen D, Bogers JP, van Dijk D, Bakker B, Schulte PF. Beyond white blood cell monitoring: screening in the initial phase of clozapine therapy. J Clin Psychiatry. 2012 Oct;73(10):1307–12.

Darling P, Huthwaite MA. Infection-associated clozapine toxicity. Clin Schizophr Relat Psychoses. 2011 Oct;5(3):159–60.

Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry. 2016 May;50(5):410–72.

Leung JG, Nelson S, Takala CR, Gören JL. Infection and inflammation leading to clozapine toxicity and intensive care: a case series. Ann Pharmacother. 2014 Jun;48(6):801–5.

Health and Well-Being Practice Guidance Note: Smoking Cessation And Clozapine. Northumberland: Tyne and Wear NHS Trust; 2007 June.

Meltzer, HY. Clozapine: balancing safety with superior antipsychotic efficacy. Clin Schizophr Relat Psychoses. 2012 Oct;6(3):134–44.

Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust N Z J Psychiatry. 2012 Aug;46(8):735–52.

Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: Overview and Treatment Options. P T. 2014 Sep;39(9):638–45.

Porcelli S, Balzarro B, Serretti A. Clozapine resistance: augmentation strategies. Eur Neuropsychopharmacol. 2012 Mar;22(3):165–82.

Ronaldson KJ, Fitzgerald PB, Taylor AJ, Topliss DJ, McNeil JJ. A new monitoring protocol for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Aust N Z J Psychiatry. 2011 Jun;45(6):458–65.

Shirazi A, Stubbs B, Gomez L, Moore S, Gaughran F, Flanagan RJ, et al. Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2016 Jun 2;17(6). pii: E863.

Stahl SM. Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. 3rd ed. New York: Cambridge University Press; 2008.

Stark A, Scott J. A review of the use of clozapine levels to guide treatment and determine cause of death. Aust N Z J Psychiatry. 2012 Sep;46(9):816–25.

Taylor D, Paton C, Kapur S. The Maudsley Prescribing Guidelines in Psychiatry. 12th ed. New Jersey: John Wiley & Sons; 2015.

The Royal Australian & New Zealand College of Psychiatrists. Schizophrenia: Australian Treatment Guide for Consumers and Carers. Melbourne: RANZCP; August, 2009. Available from: www.ranzcp.org/publications/Guidelines-and-resources-for-practice

Acknowledgements

Content team

Anita Abarno, Scott Clark, Lynda May, Kin Takayidza, Del Thomson, Lisa Wilton, Clozapine e-learning working group, SA Health

Course structure