What is the protocol for clozapine?
Clozapine should normally be started at a dose of 12.5 mg once a day. On days 2 and 3 the dose can be increased to 25 mg daily. If the patient is tolerating clozapine, the dose can be increased by 25-50 mg a day, until a dose of 300 mg a day is reached. This can usually be achieved in 2-3 weeks.
What should be monitored when taking clozapine?
Monitoring clozapine patients Baseline blood tests should check white cell count, troponins, CRP and possibly BNP3. Patients with a history of cardiac disease or abnormal cardiac findings on examination (such as QT prolongation) should be referred to a cardiologist7.
Does clozapine need to be monitored?
Clozapine is an atypical antipsychotic that is used for treatment-resistant schizophrenia. The drug is subject to strict monitoring requirements because it is associated with serious side effects, such as neutropenia, agranulocytosis, seizures, myocarditis and cardiomyopathy.
What are the requirements for a physician to order clozapine for a patient?
Prescribers who prescribe clozapine for outpatient use must:
- Certify in the Clozapine REMS Program.
- Enroll patients in the Clozapine REMS Program.
- Obtain an absolute neutrophil count (ANC) for patients in accordance with the clozapine Prescribing Information and aligned with the patient’s monitoring frequency.
When should you monitor clozapine levels?
Clozapine reaches a steady-state concentration at 5-7 days. Levels should be drawn 12 hours (± 2 h) after the last dose. Clozapine blood levels are correlated with both clozapine effectiveness and side effects.
How often should you check clozapine?
Blood monitoring is mandatory for the prescription of clozapine. White blood cell (WBC) and Neutrophil count (NC) are measured weekly for 18 weeks and every 28 days thereafter, continuing for the duration of treatment with clozapine.
Which two tests are mandatory for patients taking clozapine?
The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness.
What is the most serious risk related to clozapine treatment?
The most severe and potentially life-threatening clozapine-related blood dyscrasias is neutropenia, which may eventually develop into clozapine-induced agranulocytosis or granulocytopenia.
Can you get a 90 day supply of clozapine?
In a recent international consensus statement, recommendations were made to consider a reduced hematologic monitoring frequentcy of every 3 months with the dispensing of a 90 day clozapine supply (if safe).
How often should clozapine levels be checked?
No sooner than two to three weeks after treatment initiation and only where dose has been stable for at least the preceding 5 days. To ensure the result represents a trough level, take sample immediately before the morning dose or 10-12 hours post-dose where only one dose is taken per day.
What is a toxic level of clozapine?
Toxicity: Toxic ranges are not well established. Serum/plasma concentrations greater than or equal to 1500 ng/mL (clozapine, norclozapine and clozapine-N-oxide combined) may cause drug-induced agranulocytosis, Stevens-Johnson syndrome, seizures, hypotension, cardiovascular abnormalities, drowsiness, and death.
What happens when clozapine levels are too high?
High Clozapine Levels (>1000 ng/ml) If there is clozapine toxicity, the patient should obtain urgent care that includes symptomatic treatment and assessment for serious problems such as cardiac arrhythmias, seizure activity, or systemic infection.