Commencing a patient on a new antipsychotic – clozapine 1. Obtain a brief history of current symptoms 2. Obtain a previous drug history 3. Ask patient if they have any diseases - Immune compromise - Cardiac disease - Metabolic diseases 4. Explain the indication of clozapine as antipsychotic 5. Briefly explain mechanism of action 6. Explain that it starts at a low dose - Starts as low and slowly increased 7. Explain that current medication will be titrated down as clozapine is titrated up 8. Explain that it can take a few weeks before starting to see an effect 9. Cant to stay for sure that will get rid of voices for everyone, and everyone is different 10. Explain side effects - Infections - Rare but a series risk of a seizure - Sedation - Constipation - Chest pain - Gynecomastia - Galactorrhea - Dru mouth or hypersalivation - Hypotension or hypertension - Hyperglycaemia - Dizziness 11. Explain need for regular blood test monitoring - Blood tests – weekly ➔ Weekly for first 18 weeks ➔ Every 2 weeks for 19 weeks to 1 year ➔ After a 1 year -> every 1 month if there are no abnormalities - ECG – not sure how often ➔ Obtain a baseline ➔ 1 week, 2 week, 3 week, 4 week and then every 6 months or sooner if clinically indicated 12. Commencement to be done in the morning to allow for at least 6 hours of monitoring - Total dose may be divided unevenly to have a larger portion in the evening to help decrease daytime sedation 13. Currently orally once ot twice daily – begin at 12.5 – 25 mg - Not currently available in depot 14. Need to be inpatient for at least 2 weeks for close monitoring - If no complications can be discharged 15. Patient to be registered in the national monitoring system – clozapine patient monitoring system – to track blood results 16. Safety netting - Warm patient to seek help immediately if have a sore throat/fever - Not to stop medication without medical advice - Inform medical staff if missed any doses ➔ But don’t self-increase ➔ If less than 48 hours of clozapine missed then, the patient can continue the titration schedule starting at the dose prescribed prior to the incident ➔ Patient is advised to contact case manager or doctor if they miss taking clozapine for more than 2 days before taking their next dose as dose may need to adjusted and blood tests to done. - Do not drive if feeling drowsy - Alcohol -> enhances sedative effects and respiratory depression - Smoking -> lowers clozapine levels in blood stream -> as smoking induces CYP1A2 - Caffeine and alcohol both metabolised by CYP1A2 -> increased clozapine in the bloodstream as clozapine metabolism is inhibited