Schizophrenia is a mental illness that causes someone to have an altered experience of reality. It causes psychosis when people experience delusions and hallucinations. Schizophrenia affects people’s thoughts, perceptions and behaviour and interferes with their ability to function at work, school or relate to other people. Schizophrenia affects about 1 in 100 people[1], and the symptoms usually begin in late adolescence or early adulthood. It is generally a long-term illness and can cause serious disability when left untreated.
Clozapine is an effective antipsychotic for the management of treatment-resistant schizophrenia. Clozapine is used to treat schizophrenia when other antipsychotic medicines either have not worked or have caused severe side effects.
All patients taking Clozapine require ongoing monitoring due to potentially life-threatening side effects of this medication. Monitoring encourages the continuation of Clozapine in the presence of mild illness but defines a threshold for cessation and how to manage this.
A range of cardiac disorders have been associated with the use of Clozapine, the most serious being myocarditis and cardiomyopathy. Some symptoms require immediate medical attention and may indicate a condition called Clozapine-induced gastrointestinal hypomotility which may result in severe constipation, ileus, bowel obstruction, and even death. These symptoms include:
- No bowel movements, bowel movements less often than usual, or difficulty passing a stool
- Nausea and/or vomiting
- Bloating, tenderness and/or swelling of the abdomen
- Stomach pains and/or spasms
Due to the potentially serious adverse reactions, the use of Clozapine should be limited to consumers with schizophrenia:
- Who do not respond satisfactorily to or cannot tolerate other antipsychotic drug therapies
- Whose initial white blood cell parameters are normal
- In whom regular blood counts can be carried out
Clozapine Management Service
Our Primary Mental Health Care (PMHC) Program provides free access to psychiatric services for people experiencing financial barriers to accessing appropriate services. Our Clozapine Management Service involves connecting people using Clozapine to psychiatrists through a referral from their GP.
Eligibility
Below are the eligibility requirements for patients to access our Clozapine Management Service:
- Lives in the Western Sydney Primary Health Network region
- Is a Health Care Card holder or can demonstrate financial hardships such as unemployment
- Has a genuine need for psychiatric assessment and management of Clozapine
- They have enough medication until the psychiatrist accepts them into the program
- A WentWest Mental Health Referral form and Mental Health Treatment Plan have been completed
- A GP referral from their local GP with all relevant history including medication dosages and history has been provided
- A Clozapine Reference Number on the GP referral letter has been provided
- A review of the last six months including ECG and ECHO results has been provided
Referral
GPs must complete a WentWest Mental Health Referral form and submit this with their GP referral and any other relevant information. All referrals should be faxed to 8208 9941.
WentWest is currently offering this service with Zen Waves Clinic. They have a dedicated team of Clozapine clinicians who will provide ongoing care. Once a patient’s referral is accepted, it will be sent to Zen Waves Clinic which will call the patient to arrange an appointment.
Please note that until the patient has received a phone call from Zen Waves Clinic, the local mental health team is responsible to organise Clozapine dispensation for the referred patient. If the patient is unable to attend an appointment, they are required to provide a minimum of 24 hours’ notice.
For more information about the Clozapine Management Service, contact our Mental Health team at mentalhealth@wentwest.com.au or call 8811 7100.
For information about the implications for the medical management of Clozapine during the COVID-19 pandemic, visit the NSW Health website.
For Clozapine Product and Consumer Medicine Information, visit the Therapeutic Goods Administration (TGA) website.
17 November 2022
[1] Healthdirect (2020), Schizophrenia, access by: https://www.healthdirect.gov.au/schizophrenia