A survey of clozapine prescribing for inpatients in a tertiary psychiatric hospital

Objectives: To audit the prescribing of clozapine for inpatients at a large, specialist psychiatric hospital.

Method: The clinical standards used were agreed by the authors after reference to the clozapine data sheet and British National Formulary (BNF). Prescribing practices for forty-six patients were audited.

Results: In this population of difficult to manage, treatment-resistant schizophrenic patients, prescribing and case note documentation needed improvement. Although almost all of these patients had had an adequate trial of clozapine monotherapy, over a quarter were currently receiving clozapine augmented with another antipsychotic. Plasma clozapine monitoring was used only once in a patient who had failed to respond adequately to clozapine.

Conclusions: Clinicians should fully document the patient's consent to treatment, the clinical response to treatment and the reasons for any deviation in clinical practice from that recommended by the data sheet and national formulary. Plasma clozapine monitoring should be used to optimise therapy and clinical rating scales should be used to evaluate outcome. Until the clinical effectiveness of clozapine augmentation strategies is proven, their use should be restricted to cases where evidence-based therapies have failed.