HIGH RISK MEDICATION: CLOZAPINE

Question 2

Questions 13 and 14 relate to a 19-year-old male who started taking clozapine tablets for schizophrenia seven weeks ago.

Use the information provided about clozapine in the resource pack.

How often should this patient have their blood counts monitored when clozapine is initiated?

Select one:
A. 3-Monthly
B. 6-Monthly
C. Daily
D. Monthly
E. Weekly

Answer 2

For the first 18 weeks, blood counts should be monitored every week.

REF: https://bnf.nice.org.uk/drug/clozapine.html#indicationsAndDoses

The correct answer is: Weekly

Question 3

The patient is stabilised on therapy and has remained on the same dose of clozapine for one year. Now that he is feeling an improvement in his symptoms, he decides to work on building healthy habits including regular exercise, and quitting smoking.

Which of the following advice would be the most appropriate in relation to his clozapine?

Select one:
A. Continue with the current dose and increase frequency of blood tests to weekly
B. Continue with the current dose and monthly blood tests
C. Decrease dose and extend frequency of blood tests to 3-monthly
D. Refer to prescriber for a potential dose reduction and monitoring of plasma concentration levels Correct
E. Start nicotine replacement therapy and continue the same dose

Answer 3

Cigarette smoking induces metabolism of clozapine, resulting in significant increases in levels when quitting, hence dose adjustment and increased monitoring is required. This is not related to the nicotine component, hence the effect is not negated by NRT.

REF: https://bnf.nice.org.uk/drug/clozapine.html#interactions

The correct answer is: Refer to prescriber for a potential dose reduction and monitoring of plasma concentration levels

Question 4

Some medicines are subject to additional monitoring requirements coordinated by the manufacturer, including clozapine.
Which of the following are monitored under the clozapine patient monitoring service?

Red blood cells
Full blood count
Leucocyte count only
Leucocyte and neutrophil counts
Neutrophil count only

Answer 4

The correct answer was Leucocyte and neutrophil counts

The UK Clozaril Patient Monitoring Service (CPMS) was developed in order to manage the risk of agranulocytosis associated with clozapine. Patients are centrally monitored for their leucocyte and neutrophil counts.

Question 5

When prescribing clozapine, particular care should be taken in patients at risk of constipation, including those:

Answer 5

receiving medications known to cause constipation (especially those with anticholinergic properties such as some antipsychotics, antidepressants and antiparkinsonian treatments)

With a history of colonic disease or a history of lower abdominal surgery

Aged 60 years and older

clozapine is contraindicated in patients with paralytic ileus

Question 6

Clozapine has been associated with varying degrees of impairment of intestinal peristalsis, why?

Answer 6

These adverse events are thought to be due to the anticholinergic properties of clozapine