Clozapine – Risks in Community Pharmacy

The monitoring services are available 24 hours, 365 days a year.

In Lincolnshire, all clozapine is prescribed by the local mental health trust – Lincolnshire Partnership NHS Foundation Trust and dispensed under contract by Lincolnshire Co-op Pharmacy.

It should be rare, therefore, for any other pharmacy to be approached regarding making, or a querying a supply of clozapine.  However, there can occasionally be exceptional circumstances, including patients who present from out of the area.

• In the first instance, if approached regarding a supply of clozapine, the pharmacist should refer the patient back to their regular, monitoring service registered pharmacy.
• In the second instance, if the patient is out of area, first contact the pharmacist at the Lincolnshire Co-op Pharmacy Tel: 01522 889 562.
• In the third instance, the pharmacist should seek advice from the patient’s clozapine monitoring service.

At all times the pharmacist will need to ensure they comply with licensing restrictions described above.

Please see the Lincolnshire Joint Formulary for further information, including a link to the MHRA safety update regarding Clozapine and the potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus. This will help you to support patients who may present to your pharmacy with potential signs of Clozapine toxicity that may not be immediately obvious.

Care is also advised when providing smoking cessation advice and products, to check if the patient takes any medications that would need close monitoring, of which Clozapine is an example.

Smoking and smoking cessation: clinically significant interactions with commonly used medicines – GOV.UK (www.gov.uk)

Further resources:

Lincolnshire Joint Formulary

British National Formulary monograph