The incidence of neutropenia among clozapine-treated patients is 2% and agranulocytosis 0.8%.Some 30–60% of patients with treatment-resistant schizophrenia will respond to clozapine.Pharmacists who encounter a prescription for clozapine should establish:If the patient has been admitted to hospital, you should establish whether he or she has brought any clozapine with them.Each clozapine manufacturer has its own mandatory monitoring system. Patients newly started on clozapine must have an FBC taken weekly for the first 18 weeks of treatment then fortnightly for the next 34 weeks. Clozapine often does not appear on GP records when a list of current medicines is obtained from a surgery. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. A community pharmacy may be supplying clozapine under a service level agreement for patients receiving monthly blood tests.Contact the supplying pharmacy to find out the patient’s current dose of clozapine, when he or she last collected supplies, the brand of clozapine and the directions prescribed. If they miss more than three days of clozapine their blood testing frequency may need to change. The drug is subject to strict monitoring requirements because it is associated with serious side effects, such as neutropenia, agranulocytosis, seizures, myocarditis and cardiomyopathy. The drug is subject to strict monitoring requirements because it is associated with serious side effects, such as neutropenia, agranulocytosis, seizures, myocarditis and cardiomyopathy. Core interventions in the management of schizophrenia in primary and secondary care. Journal of Psychopharmacology 2011;25:567–620.3 Essali A, Al-Haj Haasan N, Li C, et al. Still no BOX 2, details on Traffic lighhts as mentioned above.Box 2 was in the PDF file. Arrangements can also be made for the patient to be booked into the appropriate clozapine clinic for their next FBC and for further clozapine supplies.Specialist mental health pharmacists can advise on clozapine monitoring and dose titration in certain clinical scenarios, for example, patients who are:Some hospitals have a liaison psychiatry team that can advise and monitor mental health patients and their psychiatric conditions during acute admissions.It is crucial that all staff involved with the prescribing, dispensing and administration of this medicine are trained appropriately. Therapeutic interventions to treat adverse effects are underused yet may significantly improve the quality of life of patients. To start your RPS Faculty journey today, access the portfolio and tools at If your learning was planned in advance, please click: 1 National Institute for Health and Care Excellence. In 1975, clozapine was removed from the Canadian market because of reports of life-threatening infections and deaths linked with low numbers of white blood cells (i.e., agranulocytosis). Although there is no routine monitoring for myocarditis or cardiomyopathy during treatment, patients showing signs of heart failure should have their therapy stopped until the condition is investigated. The introduction of generic clozapine has led to the establishment of other registries. Clozapine is an atypical antipsychotic that is used for treatment-resistant schizophrenia. They cannot continue taking their usual maintenance dose. under “Normal Range” monitoring once ANC ≥1000/μL or at patient’s baseline Source: Clozapine and the Risk of Neutropenia: An Overview for Healthcare Providers Version 2.0 – December 23, 2014