Clozapine monitoring in treatment resistant schizophrenia and possible ways to improve its safety (Citation and Abstract only)
Creators: name: Sakalkale, Anjali
Publisher: name: Southern Cross University
Year: 2024
Subjects: Clozapine
Myocarditis
Agranulocytosis
Schizophrenia
Drug monitoring

description: This thesis addresses the complex landscape of monitoring practices for clozapine therapy, a crucial aspect in the management of treatment-resistant schizophrenia (TRS). Schizophrenia is a psychotic illness associated with heightened mortality and long-term impairment in various aspects of life. TRS is diagnosed when trials of two antipsychotic medications prove ineffective. Clozapine is the most effective antipsychotic for TRS. However, its efficacy is accompanied by the necessity for rigorous monitoring due to associated adverse effects that may lead to morbidity and mortality. Monitoring for its adverse effects is necessary to prevent associated morbidity and mortality.
description: Hence, the research question for this study is twofold:
description: What are the current clozapine therapy monitoring protocols and disparities within the literature in Australia and worldwide? and
description: Is the existing mandatory monitoring protocol in Australia effective, and how can clozapine use be safer?
description: The overarching aim is to enhance the safety of clozapine use, aligning with the imperative to mitigate associated morbidity and mortality.
description: Part 1 of the study involved a scoping review of peer-reviewed articles, unveiling the diverse monitoring protocols worldwide. The systematic literature review uncovered variations and areas for improvement in global clozapine monitoring practices. Notable disparities were evident in monitoring haematological and cardiac adverse effects. Despite the common occurrence of clozapine-induced gastrointestinal hypomotility (CIGH) and the high risk of fatal outcomes, monitoring for its severity and evidence-based treatment was lacking in the peer-reviewed literature.
description: Part 2 of the study employed a survey distributed among clozapine prescribers and allied health workers in Australia and New Zealand to seek their insights on clinical monitoring practices. The survey results, analysed using IBM SPSS statistics, provided a practical perspective on the effectiveness of current monitoring practices, revealing ongoing fatalities and inconsistencies in clinical monitoring.
description: Part 3 focused on analysing official documents and policies related to clozapine monitoring from different Australian regions and New Zealand. Findings highlighted discrepancies in monitoring protocols. A critical observation from the findings indicated a lack of standard measures for monitoring clozapine-induced gastrointestinal hypomotility (CIGH), clozapine-induced hypersalivation (CIH), and a lack of consistency in the recommendations for platelets, thrombocyte thresholds, and an abrupt decline in white cell count.
description: Conclusively, standardised monitoring protocols and evidence-based preventive methods are urgently needed for CIGH and CIH. Finally, the outcomes of this research thesis provide new evidence regarding the currently used clozapine monitoring protocols and clinically preferred practices and make suggestions for improvement in clozapine safety procedures.