Aims and method A series of eleven patients prescribed intramuscular clozapine at five UK sites is presented. Using routinely collected clinical data, we describe the use, efficacy and safety of this treatment modality. Results We administered 188 doses of intramuscular clozapine to eight patients. The remaining three patients accepted oral medication. With the exception of minor injection site pain and nodules, side-effects were as expected with oral clozapine, and there were no serious untoward events. Nine patients were successfully established on oral clozapine with significant improvement in their clinical presentations. Clinical implications Although a novel formulation in the UK, we have shown that intramuscular clozapine can be used safely and effectively when the oral route is initially refused.

Lithium has been associated with neurotoxicity even at ‘therapeutic’ levels. This case report describes a patient with bipolar disorder who developed signs of delirium following an increase in her dose of lithium, even though her serum levels remained in the therapeutic range. Copyright © 2014 John Wiley & Sons