Clozapine and primary care

Date Published: 
Wednesday, June 30, 2021

In this episode, Dr Cheryl Buhay will discuss Clozapine and primary care- what you need to know.

Clozapine is a second generation or atypical antipsychotic prescribed for treatment-resistant schizophrenia. It is usually commenced by secondary mental health services. Clozapine is associated with several side-effects and patients require close monitoring.

GP’s are responsible for caring for these patients and this podcast provides guidance on management and monitoring.



  • 00:00 intro
  • 00:56 is it safe for GP’s to prescribe Clozapine and care for patients on this drug
  • 03:14 how often should we see these patients
  • 03:42 monitoring for constipation
  • 05:03 Porirua protocol and why it’s important
  • 07:07 teaching patients to self monitor
  • 08:31 other practical strategies for patients
  • 10:12 Red Flags
  • 11:17 cardiac toxicity and symptoms to ask about
  • 13:34 blood tests and investigations
  • 13:58 metabolic paramiters
  • 14:30 poor lifestyle choices
  • 16:10 Neutropenia and agranulocytosis
  • 17:10 Urinary incontinence
  • 18:07 Hypersalivation
  • 21:02 drug interactions
  • 23:35 Take home messages


Take-home messages

  • GPs can always access specialist metal health advice.
  • Clozapine-induced constipation is highly prevalent and can have serious consequences.
  • Monitor for symptoms of cardiac toxicity and neutropenia.
  • Metabolic monitoring should be done at least annually.
  • Be aware of potential drug interactions when prescribing medicines for someone on clozapine.
  • Substantial changes in cigarette or caffeine consumption may require a dose adjustment of clozapine.





Cheryl Buhay

Dr Cheryl Buhay is an Otago Medical School graduate and Fellow of the Royal Australia and New Zealand College of Psychiatrists.  She is working for Waitemata DHB Specialist Mental Health Services as a Primary Care Liaison psychiatrist, providing specialist support to GP practices mainly within the West Auckland area.  She is involved in GP teaching and is a contributor of mental health resources to Auckland Regional HealthPathways.

Recognition of Learning Activities

Complete and submit the learning reflection form for CPD/MOPS points provided by The Royal New Zealand College of General Practitioners below for recognition of learning activities.

Learning Reflection Form

This presentation is intended for qualified health practitioners professional development and should not be relied upon for any other purpose. Any opinions offered are those of the presenter or other speaker and do not necessarily represent the views of Goodfellow Unit.