Clozapine toxicity in spotlight after two Coroners reports
Monitoring blood concentrations of clozapine (Clozaril, Denzapine, Zaponex) for toxicity is now advised in certain clinical situations, according to recent new guidance from the MHRA.
Situations where monitoring blood levels is recommended include when:
- A patient stops smoking or switches to an e-cigarette
- Concomitant medicines may interact to increase blood clozapine levels
- A patient has pneumonia or other serious infection
- Poor (reduced) clozapine metabolism is suspected
- Toxicity is suspected.
If blood clozapine level monitoring is carried out, this should be in addition to the required blood tests to manage the risk of agranulocytosis.
The guidance comes after the MHRA received two separate reports from Coroners raising concerns about the monitoring of clozapine blood levels.
In the first report, the individual’s death was determined to have been caused by clozapine toxicity, pneumonia, and treatment-resistant schizophrenia. In the second report, the death of a patient on long-term high-dose antipsychotic treatment was determined to have been caused by coronary artery atherosclerosis and amisulpride toxicity.
Clozapine and other antipsychotic medicines are used for indications related to psychosis, including schizophrenic disorders and some forms of bipolar disorder.
Record my learning outcomes
Inspiring stories related to health, fitness and the pursuit of wellbeing
More like this
Modafinil carries significant risk of birth defects, warns MHRA
A drug used to treat sleep disorders carries a risk of birth defects when taken in pregnancy.
1 Min Article
Pharmacists eligible for £20k GP partner 'golden hello'
New to Partnership Payment Scheme gives opportunity for pharmacists to become a partner at their GP practice.
1 Min Article
Pain conversations - making effective recommendations
Explore our detailed case studies to help understand how to advise customers on different causes of pain.
15 Min Module
Covid-19 and mental health
Viatris has created this short video based on a publication reviewing global research into the potential impact of the Covid-19 pandemic on mental health. It identifies six areas where psychiatrists can play a role in supporting people's mental health through these difficult times.
4 Min Module