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 refere
nce to the clozapine data sheet and British National Formulary (BNF). Presc
ribing practices for forty-six patients were audited.
Results: In this population of difficult to manage, treatment-resistant sch
izophrenic patients, prescribing and case note documentation needed improve
ment. Although almost all of these patients had had an adequate trial of cl
ozapine monotherapy, over a quarter were currently receiving clozapine augm
ented 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 trea
tment, 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 a
nd clinical rating scales should be used to evaluate outcome. Until the cli
nical effectiveness of clozapine augmentation strategies is proven, their u
se should be restricted to cases where evidence-based therapies have failed
.