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Clozapine

Source Blood
Mnemonic CLOZ
Specimen Requirements

2 x 4 mL red top tubes, NOT SST

2.0 mL serum

Minimum Whole Blood Volumes for Micro-Collections using Microtainers

Collect just prior to next dose.

Specimen Handling

RECORD time of last dose on requisition.

PSC & RRL:
Centrifuge, pour off, and transport serum to DSC.

Extra-regional:
Centrifuge, pour off, and freeze serum prior to transport to DSC.

DSC:
Freeze specimens upon receipt in lab; ensure frozen specimens do not thaw.

Additional Information

Routine monitoring of the complete blood cell count is indicated for patients on clozapine therapy to assess toxicity.

For additional information, see Half-life and Time to Steady State.

The correlation between dose and plasma concentration is influenced by age, sex, smoking and pharmacogenetics altered by drug-drug interactions (co-administration).

Testing Location Analytical Toxicology
Testing Frequency Once weekly
Alternate Name(s) Clozaril
Reference Interval Recommended clozapine interval is 1071 to 1836 nmol/L to achieve a therapeutic response.

Significant CNS toxicity may be associated with levels >3000 nmol/L for clozapine and >2000 nmol/L for desmethylclozapine.

1. Baumann P, Hiemke C, Ulrich S, et al. The AGNP-TDM expert consensus guidelines: Therapeutic Drug Monitoring in Psychiatry. Pharmacopsychiatry 2004; 37:242-265.