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Our trust member pilots innovative method for clozapine monitoring

A point-of-care testing device which enables clinicians to perform rapid and convenient testing of clozapine levels is being piloted at South West London and St George’s.

Clozapine is a medication which can be used to treat schizophrenia when other medicines have not worked. While schizophrenia is usually managed with antipsychotic medicines, around 25% of patients do not benefit from them.

For clozapine to be prescribed, regular blood tests are required to check the levels of clozapine and white blood cells in a patient’s blood. Monitoring clozapine levels is crucial because the medication has a narrow therapeutic window, meaning that levels that are too low may be ineffective, while levels that are too high can cause side effects.

Blood tests happen every week for the first 18 weeks after clozapine is prescribed, then fortnightly for up to one year, followed by monthly tests. The results can take up to a week to be returned from the laboratory, causing a delay if a patient’s dose needs to be changed.

A point-of-care testing device that can instantly and accurately measure clozapine and white blood cell levels from a tiny drop of blood collected from a patient’s fingertip is being trialled by our Sutton clozapine clinic in the community and Lotus Assessment Suite for all inpatient services at Springfield Hospital.

Results are provided in minutes meaning clinicians can use the results to adjust the clozapine dose while they are still with a patient.

Remy Wesolowski, Physical Health & Parity of Esteem Lead Nurse, said: "These devices represent a transformative leap in enhancing care for patients prescribed clozapine, providing immediate insights into medication levels crucial for precise dosing adjustments.

“This innovative technology not only enhances the experience of our patients and treatment efficacy but also reduces the time and inconvenience associated with traditional laboratory testing, leading to more efficient and personalised patient care.”

About clozapine:

You can find detailed information about clozapine in our Patient Information Leaflet (PILL). This includes information on what the medication is for, how to take it, side effects and safety information.

To ensure clozapine is used safely and appropriately, we follow national guidance set by the Medicines and Healthcare Products Regulatory Agency (MHRA) and adhere to stringent monitoring and guidelines:

  • It is mandatory to ensure side effects are monitored regularly and effectively, and all patients newly started on clozapine have regular monitoring and weekly blood tests. This is moved to twice a week after 18 weeks and then every four weeks after one year.
  • All patients on clozapine are registered with a monitoring service and clozapine cannot be supplied unless monitoring and blood tests are up to date and within range.
  • During blood test monitoring, other aspects of physical health are also monitored for example checking for and treating constipation. Our patients attend clozapine clinics regularly for monitoring alongside their appointments with relevant clinicians.
  • Patients and carers are given written information about clozapine and offered a discussion about the side effects, how they can be managed and the benefits of clozapine

Patients and carers with questions about clozapine or any other medications can contact our Medicines Helpline on 020 3513 6829 to talk to one of our specialist mental health pharmacists. The helpline is open Monday to Friday from 9am-5pm.

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