There are several options for printing:

• Click "Print this page" on the left hand side to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• There are also leaflets which give you advice if you are unlucky enough to get an "amber" result or a "red" result after a blood test.

You can also download PILLs for pirenzepine or hyoscine for hypersalivation (too much saliva) from clozapine. These can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Clozapine is an 'antipsychotic' or 'neuroleptic' drug, used to treat the symptoms of schizophrenia in people who have not done well on at least two other similar drugs e.g. not responded or who have had bad side effects. It can also be used for psychotic symptoms in someone with Parkinson's Disease.

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The usual dose of clozapine for adults with schizophrenia is between about 200mg and 500mg a day. The top dose is 900mg a day. You may have a blood test sometimes to see how much is in your blood (this is not the same as the regular blood tests) and your dose may be changed depending on the results. The important thing seems to be how much clozapine you have each day rather then when you take it. It is quite possible to spread the usual dose out how you want to, so talk to your doctor or nurse about this.

The usual dose has to be built up slowly over the first 2-3 weeks. This is because increasing the usual dose too quickly can cause a drop in blood pressure and make some heart problems more likely.

It is not recommended in children but this is only because it has not been studied rather than because of any concerns about safety.

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Clozapine is only licensed for the symptoms of schizophrenia that haven’t got better with other medicines. Click on the links below for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Schizophrenia - main options, main medicines and handy chart

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There are many naturally occurring chemical messengers ("neurotransmitters") in the brain. Two of these are called dopamine and serotonin. Dopamine is the chemical messenger in the brain mainly involved with thinking, emotions and behaviour. In schizophrenia, this dopamine may be overactive and helps to produce some of the symptoms of the illness. The main effect that clozapine has is to block some dopamine and serotonin receptors in the brain, reducing the effect of having too much dopamine. This reduces the symptoms caused by having too much dopamine.  The action of clozapine may also be related to several other neurotransmitters in the brain.

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Take your clozapine as directed on the medicine label. Try to take it at regular times each day. Taking it at mealtimes may make it easier to remember as there is no problem about taking clozapine with or after food. If the instructions say to take them once a day this is usually at bedtime as they may make you feel drowsy at first. They are not, however, sleeping tablets.

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Clozapine tablets should be swallowed whole with at least half a glass of water whilst you are sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat. They can be broken into bits if you find the tablets too large to swallow.

A liquid clozapine suspension is available from Merz (Denzapine(R) brand). It must be shaken really well because it is a really thick liquid. It must be shaken really well for 90 seconds before you first open the bottle (because the clozapine will have sunk to the bottom of the bottle). Then, before pouring out each dose, you should shake it for 10 seconds. If you don't do this you might get less per dose at the start of the bottle, and more clozapine per dose towards the bottom of the bottle, and that might give you more side effects. If there is a layer of white solid at the bottom of the bottle when you finish it, that is clozapine and so the bottle hasn't been shaken well enough.

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Some effects of clozapine appear soon after taking it, for example the drowsiness. Click the link for the answer for the effect of clozapine on the symptoms of schizophrenia.

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This should be discussed with your doctor as people respond differently. You will probably, however, need to keep taking clozapine several years. You should have a review every three to six months, or sooner if there are problems. It is likely that you will benefit from clozapine by taking it for many years. Click this link for help on how long to take clozapine for schizophrenia.

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Clozapine is not addictive. However, if you stop clozapine suddenly, about 1 in 3 people get some mild feelings of agitation, headache and feeling sick. About 1 in 10 get feelings of feeling sick, being sick and diarrhoea that can be quite upsetting. Most of these symptoms occur within a day or two and last for up to a week. Sometimes starting clozapine again slowly at a lower dose can help.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Clozapine has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should not miss doses for more than 48 hours (2 days) in a row. If you do, you must restart your clozapine slowly (a bit like when you first went onto it). This is because when you start clozapine after a gap of more than 48 hours, it can cause your blood pressure to drop, especially when you stand up. This can be dangerous as you might then feel unexpectedly dizzy and fall over, and e.g. bang your head. Missing the occasional dose (e.g. no more than once a week) isn't usually a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, next to your bed etc.

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It is unwise to stop taking clozapine suddenly, even if you feel better. Your symptoms can return if treatment is stopped too early. This may occur some weeks or even many months after the drug has been stopped. If the clozapine has had an effect on your blood it might be important to stop the tablets suddenly. Your doctor will discuss this with you.

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The table below will show you some of the main side effects you might get from clozapine.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Clozapine may make you feel drowsy or sleepy, especially to start with. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times or reflexes. Clozapine is not, however, a sleeping tablet, although if you take it at night it may help you get to sleep. If this drowsiness does not wear off, discuss this with your doctor. It may be possible to change the timing of your doses round to help this.

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When you start clozapine you may begin to put on some weight. This weight gain tends to slow down after a time but this can be a real problem with clozapine. It is thought that clozapine causes an increase in appetite, which then makes you eat more and then put on weight. However, even if you eat less, it is still possible to put on weight, especially around the tummy area. It is not possible to know what the effect on your own weight may be because each person will be different. Unfortunately, many of the other similar medicines seem to have this effect too. If you do start to put on weight or have problems with your weight, you must tell your doctor. He or she may be able to change your clozapine dose to reduce this effect. Your doctor can also arrange for you to see a dietician for advice. Any weight you put on can be controlled while you are still taking this drug, with expert advice about diet. Make sure your doctor knows about this if it causes you distress.

Weight gain can be part of the so-called ”metabolic syndrome”. You might want to read a bit more about this.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Unlike many other antipsychotic drugs, clozapine has not been reported to have a major adverse effect on the three stages, except by causing drowsiness. However, if this happens, you should discuss this with your doctor, as a change in dose may help minimise the problem.

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If clozapine works, most people will then take it for many years and possibly the rest of their lives. So, the long-term side effects are very important, both to know what they are and what you can do about them. These also have to be balanced against the possible positive effects e.g. fewer or less symptoms, being able to get on with your life, different side effects from other treatments, and possibly living longer.

This is a summary of some of the important or common long-term side effects you might get from clozapine.

On the other hand, the largest study of its type showed that in the 1990s people with schizophrenia lived about 25 years less than the general population. With more use of the newer antipsychotics, that gap has reduced to 22.5 years over the next decade. The biggest increase in length of life (lifespan) was actually with clozapine. So, although clozapine has lots of adverse or side effects, schizophrenia has lots of adverse effects, and these can be quite serious.

The study was of everyone in Finland with a diagnosis of schizophrenia (66, 881), compared to the whole population (5,200,000) over 11 years ^{(Tiihonen et al, 2009)}. Clozapine had the lowest number of deaths from all causes, including suicides.

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You should have no problem with any foods or drinks, other than alcohol (see separate question) and caffeine.

You should be careful about drinking too much caffeine if you are on clozapine. The liver has many enzymes that break down chemicals from foods, drinks and medicines. One of these enzymes is called CYP1A2 (sometimes P450-1A2). Caffeine is broken down by CYP1A2. Caffeine (e.g. in tea, coffee, colas, Dr Pepper, energy drinks etc) can also increase the speed at which that CYP1A2 works. CYP1A2 is the enzyme that breaks down clozapine. 

The problem is that caffeine and clozapine are both broken down by the same enzyme. So, if you're taking both, sometimes it is the caffeine that gets broken down, not the clozapine. Doses of caffeine 400-1000mg a day (which is about 4 or more mugs of tea or coffee) can increase clozapine levels by an extra 25% (a quarter). This probably won't be too dangerous as such but it could be if you are on a high dose. You might get more side effects (Raaska 2004). On the other hand, if you were drinking a lot of caffeine and STOP drinking it, then your clozapine levels might drop, so it might not work as well.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

You should avoid alcohol while taking clozapine as it may well make you feel more sleepy. Alcohol in true moderation should be OK provided you do not need to drive or operate machinery afterwards. If you do become drowsy, you will need to take extra care if you need to drive or operate machinery. You must seek advice on this. 

It is not safe to drive after drinking alcohol, with or without clozapine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Clozapine should not be taken with some medicines because this can increase the chance of getting the blood problem. These medicines include phenylbutazone, penicillamine, phenothiazines (e.g. pericyazine, chlorpromazine), cytotoxics (for cancer) or carbamazepine (Tegretol). You also need to avoid some antibiotics, e.g. rifampicin, co-trimoxazole, cephalosporins, clindamycin, lincomycin, sulphonamides and trimethoprim, some anti-TBs (e.g. capreomycin, isoniazid, rifampin), dapsone, metronidazole, tinidazole, nitrofurantoin, chloramphenicol, vancomycin, teicoplanin or quinolones (e.g. ciprofloxacin, nalidixic acid).

Clozapine has a few interactions with other drugs:

• The effects of clozapine can sometimes be increased by sertraline, paroxetine (sedation), fluvoxamine, fluoxetine, erythromycin or alcohol
• The effect of clozapine can be decreased by phenytoin, phenobarbital or smoking. NB If you stop smoking while on clozapine, then the levels of clozapine in your body can increase by about 75%. This is almost the same as nearly doubling your dose. Please let your doctor or nurse know if you are planning on giving up smoking, reducing smoking or have stopped, or you might get a lot more side effects.
• Clozapine can increase the sedative effects of benzodiazepines (e.g. diazepam, lorazepam, temazepam) or alcohol

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. Make sure that your GP knows you are taking clozapine (because if your supply comes from a hospital, then he or she may forget or not know). There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

Clozapine is one of those medicines. The amount of clozapine in the body can drop by more than a third (33%) if you smoke, giving less effect or meaning you might need a higher dose to get the same effect. It also means that if you stop smoking, the levels can almost double (up to 75%) so you might get more side effects, and some deaths have been reported. This is really important so if you stop smoking with clozapine, you should have a blood test every week or so to check on your levels (not the same test as the regular blood tests). You will need a lower dose, so you must tell your carers and doctor or nurse if you decide to stop smoking. The effect may be even bigger if you are also taking valproate (e.g. Epilim® or Depakote®).

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, clozapine does not seem to be affected by cannabis as such, BUT it is by smoking so please see that section above. You may have more dry mouth, blurred vision and finding it hard to pass water (wee). Also, don't forget that cannabis can make psychotic symptoms worse.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. All antipsychotics can reduce the stimulant effects of cocaine. But some heart problems have been reported with clozapine so you need to be careful, especially if you have a heart problem.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with clozapine and ecstasy, but this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with clozapine, although you might feel more drowsy.

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You should have no problems with "The Pill" and clozapine. With many antipsychotics, a woman's periods may become irregular or even stop. This is much less likely with clozapine and so they may reappear or become more regular when starting clozapine. You also will have more chance of becoming pregnant. If you want to, that's fine. If not, you should make sure you take precautions. You need to know that a woman might still become pregnant even though her periods appear to have stopped.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking clozapine, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain (the tuberoinfundibular system if you want to know). This area of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain. This is just what we want to help reduce some of the symptoms caused by too much dopamine e.g. psychosis, paranoia. However, if these medicines also block dopamine in the area of the brain that keeps prolactin under control, prolactin can get out of control and increase. Higher than usual levels of prolactin in the brain and blood will stop your periods (or at least make them irregular or unpredictable). Much higher levels can lead to your breasts leaking milk or lactating (the medical term is galactorrhoea). The name of the hormone (prolactin) might help you guess this anyway i.e. pro- (meaning for) -lactin (as in lactation).  High prolactin can make it more difficult to become pregnant, and over many years can have an effect on your sex-life, and maybe even your bones.

Clozapine is one of those medicines that can increase prolactin. It usually only happens for a couple of months after you start it and then the effect reduces a bit. However, it can go on for longer. If this happens you should see your doctor to have a test to see if your prolactin is in fact high. So, if your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find if there are any other causes. If it is caused by clozapine then you should talk to your doctor about the options e.g. reduce the dose (which doesn't often help much), or switch to a medicine that has less effect on prolactin. Sometimes adding another medication can help if nothing else works.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Clozapine is classified as "B". The current information indicates that clozapine is not a major teratogen (i.e. a drug causing malformations). Some problems have been reported and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice. You might need a slightly lower dose while you are pregnant so might need some blood tests to check on your blood level to make sure you are not having too high a  dose.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that clozapine gets into breast milk. It can also build up in the milk. Of course it could also lead to extra drowsiness and to a blood problem (dyscrasia or agranulocytosis) in the baby, in the same way that it can do in adults (the reason all the regular blood tests). So, taking clozapine while breast-feeding is not recommended. But you should talk about this to your doctor, nurse or health visitor. If you all think it would be better to breast feed and stay on your clozapine, you should keep your dose as low as possible and the baby should have blood tests the same as you do to check the baby's blood is OK.

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Clozapine can affect your driving in two ways. Firstly, you may feel drowsy and/or suffer from blurred vision at first when taking the drugs. Secondly, clozapine can slow down your reactions or reflexes. This is especially true if you also have a dry mouth, blurred vision, constipation etc. (the so-called "anticholinergic" side effects). Until these effects wear off, or you know how your clozapine affects you, do not drive or operate machinery. You should be careful as clozapine may affect your reaction times or reflexes even though you feel well.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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Clozapine can upset the blood of about two or three people in every hundred people taking it. It can reduce the number of white cells or neutrophils in the blood (called neutropenia or agranulocytosis). This then makes it much harder for your body to fight infections. You must therefore have regular blood tests for as long as you are taking clozapine (although some of us are working at trying to change this).

Your doctor, pharmacist or nurse will let you know when and where to have the tests. You will need a test before you start clozapine, then every week for the first 18 weeks and then every 2 weeks from then on. If you have then been taking clozapine regularly for a year without any blood problems, you will only need to have blood tests every four weeks. Your blood is usually either posted a central laboratory (e.g. to the CPMS Clozaril Patient Monitoring Service, DCMS Denzapine Clozapine Patient Monitoring Service etc) or to a local hospital, who then send the results back to the Pharmacy and the Doctor. Some hospitals have their own testing machines and do the blood test on the spot (called "near patient testing") which means the result is available very quickly.

You may also need extra blood tests if it is thought possible your blood is being affected. You must not miss these tests. Your doctor and pharmacist will not be able to let you have any more tablets if you do. Remember the rule: no blood, no tablets.

With swine flu (H1N1) around, you should be extra careful. Try to get the vaccine or innoculation as soon as it is available. If you start to get the symptoms of 'flu, try to get Tamiflu as soon as possible.

We also have some leaflets which give you advice if you are unlucky enough to get an "amber" result or a "red" result after a blood test.

Some of the side effects of clozapine can include weight gain, high blood pressure, and diabetes. These are sometimes called the "Metabolic syndrome". This can happen to anyone but is more common in bipolar disorder and schizophrenia. And some medicines can also make it more likely. 

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