Monitoring the Safe Use of Clozapine

Abstract

Clozapine is an important antipsychotic agent that has a unique profile of clinical benefits, but that has also been associated with several serious and potentially life-threatening safety concerns. In order to minimise the impact of haematological adverse events, health professionals treating patients with clozapine are currently required to register their patients on a centrally administered data network and to conform to strict protocols. The consensus statement documented in this article extends existing protocols by recommending monitoring of patients treated with clozapine for additional adverse effects during treatment. This consensus statement reflects the current practice at five major public psychiatric hospitals in Victoria, Australia, for the monitoring and management of clozapine-related adverse events, and has been implemented at these sites because of emerging safety concerns associating clozapine with cardiovascular and metabolic adverse effects.

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia

“…73 Just as in other countries, 93 the availability of physical health screening guidelines has not ensured minimal screening standards are met for physical health problems such as CVD. Screening and monitoring protocols and guidelines are available in Australia 45,46,54,70,75,77,94 (see Table 2) and overseas. 47 Further, although screening is important, this should be followed by effective, evidence-based interventions.…”

“…39,48 Randomised controlled trials have been conducted for smoking 49 and diet, 50 and several lifestyle programs have been evaluated using other methods. 51,52 These developments have followed emerging consensus on policy and care management approaches to mental and physical illness cooccurrence where the mental health system is viewed to be important (not primary care alone), 53 the side-effects of psychotropic drugs are acknowledged 54,55 and the physical health risks encountered more by people with mental illness are better understood. 56 Notably, targets, goals and requirements for reporting progress on reduction of physical ill-health and improved life expectancy have been recently formulated in government policy, advisory bodies, international declarations and in the Connecting policies outside of health system that impact people's health (e.g.…”

Physical complications in early clozapine treatment: a case report and implications for safe monitoring

“…A more frequent monitoring regime was suggested, with FPG recommended at baseline then at 4, 8 and 12 weeks after starting treatment. A less stringent monitoring view is taken in Berk and colleagues' consensus statement, which recommends baseline and 6-monthly FPG testing [Berk et al 2007]. There is however a proviso that testing should be conducted following dose changes, or if clinically, diabetes is suspected.…”

Prevalence and Predictors of Metabolic Syndrome Among Patients Attending an Outpatient Clozapine Clinic in Australia

“…Although attempts at determining prevalence rates of MS need to continue among patients, the associates of the syndrome are all known to be modifiable risk factors. Several recent publications provide frameworks for the management of metabolic considerations in the context of antipsychotic medication prescription (Newcomer, 2007a(Newcomer, , 2007bSernyak, 2007;Berk et al, 2007). Attempts have been made at modifying the components of MS among clozapine patients, predominantly with diet and exercise interventions (Wu, Wang, Bai, Huang, & Lee, 2007), pharmacological approaches (Henderson et al, 2005), and increase of patient's knowledge of MS (Brunero, Lamont, Myrtle, & Fairbrother, 2008).…”