WA Clozapine initiation and titration chart

OD 0596/15 WA Clozapine Initiation and Titration Chart (external site)

Clozapine is well recognised as a high risk medication.

Clozapine was initially released in the early 1970s and withdrawn from the market in 1975 due to incidents of neutropenia, myocarditis and sudden death. It was reintroduced for use in Australia as an antipsychotic for the management of treatment-resistant schizophrenia.

Each patient being treated with clozapine must be registered with a clozapine patient monitoring system. Stringent and frequent monitoring requirements include white cell counts and neutrophil levels at baseline, initiation and maintenance therapy. Vital observation signs (includes blood pressure, pulse, temperature and respiratory rate) are monitored very frequently during initiation and re-titration of clozapine therapy. These signs are monitored hourly for the first six hours of treatment, and then six hourly for the first 24 hours. A minimum of twice daily monitoring is then required for days 2 – 7 of clozapine therapy.

The frequency of observations required for clozapine commencement differs from the standard mental health routine observations that would be in place for a patient commencing any other drug. Observations during the first 7 days of therapy MUST be documented on the front of the WA Clozapine Initiation and Titration Chart AND on the Adult Observation and Response Chart (AORC) used within the organisation. All observations must be reviewed by the treating team.

The use of the WA Clozapine Initiation and Titration Chart (Clozapine Chart) is restricted to mental health inpatient units under the supervision of a psychiatrist. The Clozapine Chart facilitates clinical handover and prescription for the safe management of patient initiated or re-titrated on clozapine. Decision support is also provided on the chart.

The chart was developed by the Quality Improvement and Change Management Unit in consultation with the Office of the Chief Psychiatrist, with input from psychiatrists, nurses and pharmacists from Fremantle Hospital and Health Service (FHHS) and Graylands Hospital.

The chart has been endorsed by:

  • WA Therapeutic Advisory Group (WATAG)
    • WA Medication Safety Group (WAMSG)
    • WA Psychotropic Drug Committee (WAPDC)
  • Office of the Chief Psychiatrist
  • State Executive Directors of Nursing and Midwifery

Resources for health professionals:

More information

Quality Improvement and Change Management Unit
Address: 189 Royal Street, East Perth
Phone: 9222 4080
Email: qicm@health.wa.gov.au

Produced by

Quality Improvement and Change Management Unit