PLASMA CLOZAPINE ASSAY REQUEST FORM
Please send the completed form with a blood sample (at least 2 mL - collect into EDTA tube) to:
Dr RJ Flanagan, Toxicology Unit, Bessemer Wing, King’s College Hospital, Denmark Hill, London SE5 9RS Tel: 020 3299 5881, Fax: 020 3299 5888, e-mail: kch-tr.toxicology@nhs.net *** Pack safely to Post Office regulations - Use KingsPath address envelopes (available from the CPMS) - Do not send with courier for CPMS FBC ***
Take the sample before a morning dose or in the morning after an evening dose (“trough sample”). Sampling < 6 h post-dose may make the results difficult to interpret/compare with previous results
Serum can be analysed although plasma is preferred
Addresses to which the report and invoice are to be sent must be supplied. The assay cost is £25 per sample. The report will be sent to the consultant, unless other arrangements are specified or in place. Assay results will be available on-line within 2 working days of sample receipt (log on to to register with our free, secure Results On-Line service). Patient Report and invoice Clozaril Patient Monitoring Service No *Address for report & invoice (if invoice address is different, use space below)
Baseline value? Poor / non-compliance?
Dose correct? Drug interaction?
*Address for invoice (& cost centre if needed)
Adverse reaction? Other (please give details)? Postcode * Invoice details may be omitted if invoice address/cost centre already notified for this patient
This form may be photocopied or downloaded (http://www.clozaril.co.uk)
Plasma Clozapine Assay Service – Clozaril Patient Monitoring Service Guide BACKGROUND Clozapine is a second generation antipsychotic used to treat schizophrenia resistant to conventional therapy. Adverse effects may include hypotension, lethargy, somnolence, hypersalivation, and constipation. There is a risk of seizures at higher doses/plasma concentrations. There is evidence that clozapine metabolism is saturable at higher dose. Smoking habit has a big (on average ± 50 % smokers/non smokers) effect on clozapine dose requirement CLINICAL APPLICATION
Dose adjustment: ‘trough’ plasma concentrations ≥ 0.35 mg/L are suggested to ensure a fair trial of the drug
Assessment of the impact of changes in smoking habit on clozapine dose requirement
Investigation of possible dose-related adverse effects
Note: Patient consent should be obtained before taking a sample for clozapine monitoring. Information given on the assay request form will be entered on a computer database and used to help interpret the result or improve result interpretation in future. The information provided on the request form is not made available to CPMS. SAMPLE REQUIREMENTS Minimal sample requirement 2mL EDTA blood - collect blood and mix well (do not shake). ‘Trough’ samples are preferred, either pre-dose or minimum 6 hours post-dose STORAGE AND TRANSPORT Pack safely to Post Office regulations using KingsPath address envelopes (available from the CPMS) THE KINGSPATH PLASMA CLOZAPINE ASSAY SERVICE – RESULTS ON-LINE
Full CPA accreditation with participation in external quality assessment (Heathcontrol (LGC Standards)
Consultant-led service – Clinical interpretation and advice available based on 18 years of service provision
Fast Turnaround - Clozapine and norclozapine (N-desmethyclozapine) results will be available on-line within 2
working days of sample receipt (log on toto register with our free, secure Results On-Line service). VISIT- For further information and to preview the KingsPath Results On-line service. CONTACT:Tel: 020 3299 5881, Fax: 020 3299 5888, e-mail: kch-tr.toxicology@nhs.net References A Rostami-Hodjegan, AM Amin, EP Spencer, MS Lennard, GT Tucker, RJ Flanagan. Influence of dose, cigarette smoking, age, sex and metabolic
activity on plasma clozapine concentrations: a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients. J Clin Psychopharmacol 2004; 24: 70-8.
B Yusufi, S Mukherjee, R Flanagan, C Paton, G Dunn, E Page, TR Barnes. Prevalence and nature of side effects during clozapine maintenance
treatment and the relationship with clozapine dose and plasma concentration. Int Clin Psychopharmacol 2007; 22: 238-43.
YQ Xiang, ZJ Zhang, YZ Weng, YM Zhai, WB Li, ZJ Cai, QR Tan, CY Wang. Serum concentrations of clozapine and norclozapine in the prediction of
relapse of patients with schizophrenia. Schizophr Res 2006; 83: 201-10
CA MacCall, N Billcliff, W Igbrude, S Natynczuk, EP Spencer, RJ Flanagan. Clozapine: More than 900 mg/d may be needed. J Psychopharmacol
L Couchman, PE Morgan, EP Spencer, RJ Flanagan. Plasma clozapine, norclozapine, and the clozapine:norclozapine ratio in relation to prescribed
dose and other factors: Data from a Therapeutic Drug Monitoring service, 1993-2007. Ther Drug Monit 2010; 32: 438-47.
L Couchman, PE Morgan, EP Spencer, A Johnston, RJ Flanagan. Plasma clozapine and norclozapine in patients prescribed different brands of
clozapine (Clozaril®, Denzapine®, and Zaponex®). Ther Drug Monit 2010; 32: 624-7.
RJ Flanagan. A practical approach to clozapine therapeutic drug monitoring. CMHP Bull 2010; Issue 2 (June): 4-5. RJ Flanagan. Clozapine therapeutic drug monitoring: Why is it important? B.J.Clin Pharmacy 2011; 3 :18-20
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PLASMA CLOZAPINE ASSAY REQUEST FORM 
Plasma Clozapine Assay Service – Clozaril Patient Monitoring Service Guide