What Went Wrong: Clozapine Bloodwork Monitoring
Clozapine is a drug used to treat severe schizophrenia and schizoaffective disorder. While it is an effective antipsychotic, patients using clozapine have a small but significant risk of developing agranulocytosis (severe lack of white-blood cells).
Every patient on clozapine therapy in Canada is required to complete bloodwork as a condition of dispensing the drug. As clozapine is not as frequently dispensed as other medications of this class, it is particularly important that pharmacists dispensing it be diligent about monitoring patient bloodwork.
Clozapine bloodwork monitoring is an ongoing issue the College continues to remind registrants. See What Went Wrong: Clozapine for an outline of many questions patients and pharmacists ask about drug therapy involving clozapine.
The College received a complaint that a pharmacy had been dispensing clozapine daily for over a year without ensuring the patient was having regular bloodwork drawn. The pharmacy continued to dispensed clozapine daily despite a mental health care team following the patient. Additionally, the manufacturer sent three reminders for the patient to have bloodwork drawn, the pharmacy never followed up, and the patient never went for bloodwork.
Following an investigation, the Inquiry Committee determined that the pharmacy must have a clozapine bloodwork monitoring protocol. This will ensure the dispensing pharmacist confirms the patient has had recent bloodwork drawn even if there is a health care team involved, before dispensing a clozapine prescription.
A full pharmacist must
Best Practices for a pharmacy receiving a new Clozapine prescription
- Confirm the prescription with the prescribing physician and/or clinic.
- Confirm the “Monitoring Company” the physician will be using (such as the APOTEX or GENPHARM program).
- Ensure the patient is issued an “ID Number” from the “Monitoring Company” prior to filling the prescription.
- Confirm and document the frequency of patient monitoring.
- Ensure the pharmacy is set up to receive the results from the “Monitoring Company” (either by fax or access to the website – the pharmacy will need to set up usernames and passwords to login)
- Confirm with the patient the lab they will be using, the frequency of monitoring and reminding the patient of the importance of being compliant.