Clozapine and primary care

In this episode, Dr Cheryl Buhay will discuss Clozapine and primary care- what you need to know.

Clozapine is a second generation or atypical antipsychotic prescribed for treatment-resistant schizophrenia. It is usually commenced by secondary mental health services. Clozapine is associated with several side-effects and patients require close monitoring.

GP’s are responsible for caring for these patients and this podcast provides guidance on management and monitoring.

Topics

Intro
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is it safe for GP’s to prescribe Clozapine and care for patients on this drug
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how often should we see these patients
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monitoring for constipation
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Porirua protocol and why it’s important
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teaching patients to self monitor
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other practical strategies for patients
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Red Flags
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cardiac toxicity and symptoms to ask about
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blood tests and investigations
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metabolic paramiters
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poor lifestyle choices
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Neutropenia and agranulocytosis
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Urinary incontinence
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Hypersalivation
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drug interactions
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Take home messages
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Take home messages

GPs can always access specialist metal health advice.
Clozapine-induced constipation is highly prevalent and can have serious consequences.
Monitor for symptoms of cardiac toxicity and neutropenia.
Metabolic monitoring should be done at least annually.
Be aware of potential drug interactions when prescribing medicines for someone on clozapine.
Substantial changes in cigarette or caffeine consumption may require a dose adjustment of clozapine.

Resources

Gut care: patient handout - Dr Cheryl Buhay
Gut care: prescriber handout - Dr Cheryl Buhay
Clozapine_quick_reference for General Practice prescribers - Dr Cheryl Buhay
Clozapine: Safe prescribing - BPAC NZ

Presenter

Cheryl Buhay

Psychiatrist

Dr Cheryl Buhay is an Otago Medical School graduate and Fellow of the Royal Australia and New Zealand College of Psychiatrists. She is working for Waitemata DHB Specialist Mental Health Services as a Primary Care Liaison psychiatrist, providing specialist support to GP practices mainly within the West Auckland area. She is involved in GP teaching and is a contributor of mental health resources to Auckland Regional HealthPathways.