The following is the minimum information that should be included in a treatment plan submitted to clozapine monitoring service for approval of using a contraindicated medication with clozapine. Examples of such medicines include carbamazepine, cytotoxic chemotherapy and disease modifying drugs like methotrexate.  

1. Contraindicated concomitant treatment:

• indication and rationale for contraindicated treatment
• name of treatment
• predicted treatment course and provisional end date
• potential impact of this treatment on haematological factors
• name and designation of physician responsible for the relevant treatment (haematologist, oncologist, etc)

2. Altered monitoring parameters for WCC/ neutrophils/ platelets (if these are to differ from standard clozapine monitoring parameters) including;

• threshold for stopping/ making alterations to concomitant treatment
• and threshold for stopping clozapine therapy

NB Although the intention would be to continue management with clozapine throughout the treatment plan, consideration must be given to what is done in the event of a catastrophic reduction in neutrophils and the development of agranulocytosis.

If the patient’s management is to include the use of G-CSF (granulocyte-colony stimulating factor) to manage a neutropenic episode, the treatment plan should clearly state the thresholds for initiating this.

3. Altered frequency for FBCs whilst on treatment plan (if different to standard monitoring). Frequency of monitoring often increases to at least weekly during management with concomitant treatment and for a period of time after treatment has ceased.

4. Any other monitoring that is to be put in place e.g. closer monitoring of standard observations.

5. Roles and responsibilities of all disciplines involved in the ongoing management of the treatment plan.

6. Names and contact numbers for key personnel in case of issues out of hours; eg clozapine monitoring service, haematology/oncology on call contact numbers, etc.

7. The 3 UK clozapine manufacturers have different procedures for rechallenge so the clozapine monitoring service that the patient will be registered with should be contacted to confirm what process and further documentation is required.

 8. A copy of the treatment plan should be sent to Leverndale pharmacy and copies kept within the patient’s care plan