It is essential that community mental health teams and wards communicate with Leverndale pharmacy as soon as they become aware of a clozapine patient’s holiday plans.

Early communication allows appropriate planning to be undertaken to ensure the necessary blood monitoring and dispensing takes place to cover the patient’s holiday period.

In the majority of cases patients will take a holiday of up to 14 days. This can usually be accommodated with appropriate adjustment of the blood sampling to allow dispensing of an adequate supply.

In the event of an off-label supply being required, the 3 clozapine manufacturers have different off–label procedures so the clozapine monitoring service that the patient is registered with should be contacted to confirm what process and documentation is required. 

The rules around clozapine allow a maximum dispensing of 10 days (14 for patients registered with ZTAS) of clozapine from the date of the last sample for people on weekly blood monitoring.

Consequently holidays for periods of up to 8 days (12 for patients registered with ZTAS) can be easily managed with enough notice.

In this circumstance a local blood sample should be taken as close to the departure date as possible and an appropriate supply to cover the holiday period will be made once the result of that blood sample is known. The patient should have another local blood sample taken as soon after they return from holiday as possible.

If the holiday is for more than 8 days (12 for patients registered with ZTAS):

• Take a local blood sample as close to the departure date as possible.
• It is likely that it will not be possible to take another blood sample before the 10 day (14 days with ZTAS) validity of the pre-holiday sample lapses.
• Pharmacy will have to make a supply for more than 10 days to accommodate that.
• That is an off-label supply and therefore an off-label agreement will have to be agreed by the appropriate monitoring service to allow an extended supply to be issued. 
• The exact quantity supplied will depend on the date of the post-holiday blood sample.

The rules around clozapine allow a maximum dispensing of 21 days of clozapine from the date of the last sample for people on fortnightly blood monitoring.

Consequently holidays for periods of up to 19 days can be easily managed with enough notice.

In this circumstance a local blood sample should be taken as close to the departure date as possible and an appropriate supply to cover the holiday period will be made once the result of that blood sample is known. The patient should have another local blood sample taken as soon after they return from holiday as possible.

If the holiday is for more than 19 days:

• Take a local blood sample as close to the departure date as possible.
• It is likely that it will not be possible to take another blood sample before the 21 day validity of the pre-holiday sample lapses.
• Pharmacy will have to make a supply for more than 21 days to accommodate that.
• That is an off-label supply and therefore an off-label agreement will have to be agreed by the appropriate monitoring service to allow an extended supply to be issued. 
• The exact quantity supplied will depend on the date of the post-holiday blood sample.

The rules around clozapine allow a maximum dispensing of 42 days of clozapine from the date of the last sample for people on 4 weekly blood monitoring.

Consequently holidays for periods of up to 40 days can be easily managed with enough notice.

In this circumstance a local blood sample should be taken as close to the departure date as possible and an appropriate supply to cover the holiday period will be made once the result of that blood sample is known. The patient should have another local blood sample taken as soon after they return from holiday as possible.

If the holiday is for more than 40 days;

• Take a local blood sample as close to the departure date as possible.
• It is likely that it will not be possible to take another blood sample before the 42 day validity of the pre-holiday sample lapses.
• Pharmacy will have to make a supply for more than 42 days to accommodate that.
• That is an off-label supply and therefore an off-label agreement will have to be agreed by the appropriate monitoring service to allow an extended supply to be issued. 
• The exact quantity supplied will depend on the date of the post-holiday blood sample.
• For holidays in excess of 42 days follow extended holidays guidance.

On rare occasions patients and their families go on extended holidays (42 days or more).

In these exceptional circumstances bespoke arrangements need to be put in place and this will involve discussion with relevant monitoring service and potentially healthcare systems at the destination to co-ordinate blood monitoring and supply.

Please contact pharmacy as early as possible to enable planning to take place to organise such trips.

To access information about clozapine in a number of languages contact Mental Health Pharmacy Services.