ReciteMe Logo

Medicines Supply

Arrangements for continuity of supply of Clozapine from CNTW following admission to an Acute Trust (from April 2023 onwards)

To: All Acute Trust Emergency Duty Pharmacists, Pharmacy Leads and Medicines Safety Officer – North Cumbria
From: Ruth Ayre, Deputy Chief Pharmacist, CNTW
Date: 29th March 2023
Subject: Arrangements for continuity of supply of Clozapine from CNTW following admission to an Acute Trust (from April 2023 onwards)

When a patient taking clozapine is admitted to your Trust, please contact your local Psychiatric Liaison Team (via switchboard). These multidisciplinary teams often include CNTW clinical pharmacists, who can support ongoing management.

Note: CNTW stock and supply the Denzapine® brand of clozapine

Admission from CNTW inpatient ward

  • When transferred from a CNTW inpatient ward, a patient-specific clozapine supply will be transferred with the patient
  • CNTW will continue to supply the clozapine during their admission and at discharge, and will pick them up under normal arrangements thereafter
  • To avoid the risk of relapse and extended in-patients stays, it is very important that, where clinically appropriate, ongoing clozapine treatment is unbroken. Ward pharmacy teams have an important part to play in ensuring that medicines reconciliation is completed promptly following patient transfers.

Admission from community

  • The patient/carer should be encouraged to bring in the patient’s own supply of clozapine to use during the admission and at discharge, where there is sufficient supply
  • Where the patient is using a multi-compartment compliance aid (MCA), new supplies will only be issued by CNTW pharmacy where there are multiple medicines contained within the MCA, or where the clozapine is unable to be accurately identified by Acute Trust staff
  • To avoid the risk of relapse and extended in-patients stays, it is very important that, where clinically appropriate, ongoing clozapine treatment is unbroken. Ward pharmacy teams have an important part to play in ensuring that medicines reconciliation is completed promptly following admission to hospital

Arranging clozapine supplies from CNTW

Hospital Pharmacy teams (Mental Health and Acute Trust) must liaise effectively regarding the supply of clozapine, including when doses change and/or following decisions taken to pause/stop treatment.

  • When a supply of clozapine is required during working hours (Mon to Fri 8:30-16.30hrs) send a copy of the current inpatient prescription for clozapine to [email protected]
  • Please ensure you follow up this e-mail with a telephone call to Carleton Clinic dispensary on Tel. 01228 608 269 to confirm receipt
  • Details of the destination to where the clozapine supply should be sent must also be provided and transport arranged by the Acute Trust
  • The CNTW pharmacy team will check the Denzapine Monitoring Service (DMS) system for blood monitoring status before supplying clozapine to ensure there is a Green result to allow for a supply to be made. Recent blood results may need to be provided (White Cell/Neutrophil/Platelet levels).
  • They will advise Acute Trust staff when a blood test is next required for subsequent routine supply – this will include white blood cell, platelet and neutrophil counts
  • Blood monitoring results should be telephoned through to the DMS (tel:0118 920 9500 – option 3).
  • If there are any significant changes to blood results at any point during the patient’s admission or if clozapine treatment is stopped, these details should be telephoned through to the DMS by Acute Trust staff. Advice regarding changes to the monitoring required may be given

Outside of normal working hours supply

  • Should a supply of clozapine be required outside of the normal CNTW pharmacy opening hours, please contact the CNTW EDC Pharmacist via Carleton Clinic Switchboard (Tel. 01228 602 000)

Non-CNTW patients admitted to an Acute Trust

  • Contact the patient’s usual supplying Trust pharmacy or use the patient’s existing supply
  • Where this is not possible, CNTW are able to supply Denzapine® as stock (i.e. not labelled for an individual patient) for the Acute Trust to dispense to the patient, including out-of-hours if necessary
  • Supply requests must be accompanied by a written order, in the form of a temporary stock request
  • Note: the responsibility for undertaking blood testing and reporting to the relevant clozapine monitoring service rests with the Acute Trust
  • If the patient normally takes a different brand of clozapine than Denzapine®, (Clozaril® or Zaponex®), obtain a supply of this brand from the patient’s usual source, for use during admission and at discharge– the relevant clozapine monitoring service would need to be contacted by Acute Trust staff
  • If this is not possible, a temporary switch to Denzapine® maybe required, including re-registration with DMS – contact the local Psychiatric Liaison Team or CNTW pharmacy for advice and support

Clozapine re-titration/missed dose guidance

  • Less than 48 hours: When a patient has missed less than 48 hours of clozapine treatment, the dose does not need to be altered or re-titrated and the usual dose can be continued
  • More than 48 hours: When a patient has missed more than 48 hours of their clozapine treatment, their dose will need re-titrating
  • Contact the local Psychiatric Liaison Team, prescriber or CNTW clinical pharmacy team for advice on how to do this
  • They can arrange to send a blank CNTW clozapine titration form to be used as guide for prescribing as well as information regarding the physical health monitoring and observations required

In addition, further information and advice is also available from the CNTW Responsible Pharmacist or Pharmacy Medicines Information, Tel. 0191 245 6606; [email protected] (Mon-Fri 8.30am – 5pm)