Supply of clozapine

Memo

To:    All Acute Trust Emergency Duty Pharmacists, Pharmacy Leads, Medicines Safety Officers and Points of contact (CNTW) – North Cumbria

From:    Ruth Ayre, Deputy Chief Pharmacist, CNTW

Date:        29th March 2025

Subject:    Arrangements for continuity of supply of Clozapine from CNTW following admission to an Acute Trust 

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. Where the admission occurs outside of usual Pharmacy opening times, permission may be given by a pharmacist to utilise this MCA until a new supply can be made.

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 8.30am-4.30pm) send a copy of the current inpatient prescription for clozapine to carletonclinicpharmacy@cntw.nhs.uk 
• Please ensure you follow up this e-mail with a telephone call to Carleton Clinic dispensary on 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 (telephone: 0333 200 4141 – option 1). 
• 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 Emergency Duty Pharmacist via  Carleton Clinic Switchboard (Telephone: 01228 602 000)
• CNTW will need a copy of the patients prescription (e.g. inpatient treatment chart) scanned to facilitate suppy. This may be scanned to the CNTW Point of Contact or Emergency Duty Pharmacist (details will be given at the ime of the call)  to enable supply from a CNTW Emergency Drugs Cupboard. 

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 copy of a prescription, e.g. inpatient treatment chart. An order will be created by CNTW to facilitate the supply.
• 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, Telephone: 0191 2456 606; Email: medinfo@cntw.nhs.uk  (Mon-Fri 8.30am – 5pm)
 

Memo

To:    All Acute Trust Emergency Duty Pharmacists, Pharmacy Leads,  Medicines Safety Officers and Points of Contact

From:    Ruth Ayre, Deputy Chief Pharmacist, CNTW

Date:        29th March 2025

Subject:    Arrangements for continuity of supply of Clozapine from CNTW following admission to an Acute Trust

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. Where the admission occurs outside of usual Pharmacy opening times, permission may be given by a pharmacist to utilise this MCA until a new supply can be made.
• 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 8.30am-5pm) send a copy of the current inpatient prescription for clozapine to pharmacydispensarysnh@CNTW.nhs.uk  
• Please ensure you follow up this e-mail with a telephone call to SNH dispensary 0191 245 6606 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 (telephone: 0333 200 4141 – option 1).
• 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 Emergency Duty Pharmacist via  St Nicholas Hospital switchboard (Telephone: 0191 246 6800)
• CNTW will need a copy of the patients prescription (e.g. inpatient treatment chart) scanned to facilitate suppy. This may be scanned to the CNTW Point of Contact or Emergency Duty Pharmacist (details will be given at the ime of the call) to enable supply from a CNTW Emergency Drugs Cupboard. 

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 copy of a prescription, e.g. inpatient treatment chart. An order will be created by CNTW to facilitate the supply.
• 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, Telephone: 0191 245 6606; Email: medinfo@cntw.nhs.uk  (Mon-Fri 8.30am-5pm)