Information about the Metabolic Health Initiative for clinicians, including resources to help support the physical health of mental health service consumers.
Clinical resources - Clozapine
Information relating to all aspects of clozapine management for community clozapine coordinators, inpatient clinical staff, pharmacists, medical officers, and all other staff associated with caring for a person prescribed clozapine can be found here.
The Clozapine Management Clinical Guideline (CMCG) (PDF 3.95MB) provides all the information required to safely manage people prescribed clozapine. The CMCG provides stepped instruction for the commencement, management and when required recommencement of clozapine. For SA Health clozapine clinics and all those in shared care with an SA Health clozapine clinic, adherence to the CMCG is expected.
Guidelines and algorithms
The guidelines and algorithms below are part of the CMCG, individually identified for easy access and use:
- Clozapine Cardiac Guidelines (PDF 107KB) - provides management instruction for required monitoring and raised cardiac assays.
- Psychotropic Induced Constipation Guideline (PDF 106KB) - provides a suggested constipation management protocol.
- Adolescent Positive Cardiometabolic Health Algorithm (PDF 1.4MB) - provides advice on interventions following metabolic health screening specifically targeted at adolescents.
Positive Cardiometabolic Health Algorithm (PDF 1.4MB) - provides advice on interventions following metabolic health screening
- Metformin - prescribing in adults guideline (PDF 113B) - provides information for the introduction of Metformin into the medication regimen to help in the reduction of obesity and weight gain in people.
Important drug interaction information
The information below relates to clozapine drug interactions and toxicity:
- Clozapine Toxicity and Therapeutic Drug Monitoring Fact Sheet (PDF 135KB)
- Off label use Atropine Eye Drops Fact sheet (PDF 252KB)
- Factors influencing Clozapine plasma concentrations (PDF 528KB)
A potential severe gastrointestinal adverse effect of clozapine treatment is clozapine induced gastrointestinal hypomotility (CIGH), commonly referred to as ‘slow gut’ which may result in severe constipation, ileus, bowel obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death.
CIGH is significantly more common than blood dyscrasias and has a reported higher mortality rate.
- Psychotropic Induced Constipation Guideline (PDF 106KB)
- Choice and Medication - Clozapine and Constipation Fact Sheet (PDF 161KB)
- NPS Medicinewise Article - NHMRC Guidelines - Managing Constipation in Adults
Evidence shows that COVID-19 infection can have adverse effects on Clozapine levels and white cell counts, leading to clozapine toxicity or neutropenia. SA Health have introduced COVID-19 positive guidelines to monitor people prescribed clozapine in the event of an infection. Clozapine also adversely interacts with antiviral medication, Paxlovid.
- Clozapine Strategic Management Group: Clozapine and COVID-19 Vaccination (PDF 88KB)
- Management of people, COVID-19 positive, prescribed Clozapine (PDF 243 KB)
- Antiviral treatments for mild COVID-19 disease, including people prescribed clozapine (PDF 168KB)
Nurse led clozapine clinics
SA Health Mental Health Services (MHS) have Nurse led clozapine clinics in metropolitan Local Health Networks (LHN), to monitor people prescribed clozapine. The resources below will assist in understanding the nurse led clinic processes, questions to be asked of people prescribed clozapine, and the management of abnormal/adverse events.
- Flowchart - Nurse Led Clinics Model (PDF 49MB)
Pathways and Protocols for Managing Abnormal/Adverse Events - Nurse Led Clozapine Clinics (PDF 89KB)
- Questions to ask at Clozapine reviews (PDF 28KB)
- Clozapine clinic journey (PDF 267KB)
- Clinic consumer questionnaire (PDF 42KB)
- Community Mental Health Services - Clozapine pathways (PDF 109KB)
Communication between services is essential for the safe management of people prescribed clozapine. The pathways below define the expected communication processes.
- Communication with Community/Inpatient Clozapine Coordinators PDF 22KB)
- ED protocol for consumer on clozapine (PDF 21KB)
- General hospital ward protocol for consumer on clozapine (PDF 21KB)
GP and Private Psychiatrist Shared care protocols
Shared care arrangements between MHS and general practice (GP) and/or Private Psychiatrists is a major part of clozapine management and integrating GP care into the person’s overall health and wellbeing.
The pathways below show the formalised clozapine shared care with MHS for all stages of clozapine management:
- Green - Shared Care Arrangements Clozapine Pathways (PDF 110KB)
- Amber - Shared Care Arrangements - Clozapine Pathways (PDF 102KB)
- Red - Shared Care Arrangements Clozapine Pathways (PDF 102KB)
Information for people prescribed clozapine and their carers
The brochures below provide people prescribed clozapine and their carers important information they need to know about the requirements of clozapine management:
- clinic consumer questionnaire (PDF 42KB)
- consumer information brochure (PDF 433KB)
- Clozapine information for carers and support persons (PDF 305KB)
- Clozapine care card template (PDF 232KB)
- Clozapine consumer body temperature information template (PDF 402KB)
Clozapine education is available online through:
- Learning Central - for SA Health employees
- High Risk Medication Education - for health professionals, GPs and people outside of SA Health.
Alert instructions and screen captures
SA Health have designated clozapine management record screens found in the Community Based Information System. People on clozapine also require alerts to be added into the OACIS and Sunrise electronic medical record systems. The information below provides instructions for completing the required alerts:
- Clozapine Alert - Create/Update/Inactivate (OACIS alerts system) (PDF 460KB)
- GP Clozapine screen captures (PDF 33KB)
- Clozapine Review - CBIS screen captures (PDF 187KB)
- Clozapine Alert - CBIS screen captures (PDF 89KB).
Forms and protocols
Clozapine management forms used in SA Health are available to order through Oracle for all aspects of clozapine care. Examples of the forms are below:
- MR74D - Example Clozapine Commencement Form (PDF 693KB)
- MR75D - Example Clozapine Investigation Review (PDF 517KB)
- MR76D - Example Clozapine Transfer of Care (PDF 501KB)
- MR77D - Example Clozapine Patient 4 weekly Protocol (PDF 518KB)
- MR78D - Example Patient Protocol Recommencement (PDF 517KB)
GP Shared Care 4 weekly clozapine patient protocol
The 4 weekly clozapine patient protocol form is available in rtf. formats for GP and private psychiatrist software.
Instructions on how to import the form into clinical management applications are available below:
Download RTF templates
Once downloaded, do not open the rtf. file as the embedded links will break.
- Best Practice - 4 weekly clozapine patient protocol (RTF 194KB)
- Medical Director - 4 weekly clozapine patient protocol (RTF 125KB)
- Zedmed - 4 weekly clozapine patient protocol (RTF 177KB)
View PDF versions
To view the form contents select the PDF version:
- Best Practice - 4 weekly clozapine patient protocol (PDF 884KB)
- Medical Director - 4 weekly clozapine patient protocol (PDF 891KB)
- Zedmed - 4 weekly clozapine patient protocol (PDF 879KB)