{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:28:56Z","timestamp":1777879736776,"version":"3.51.4"},"reference-count":53,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Psychopharmacology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12\u2009weeks in those patients taking clozapine for more than 1\u2009year. To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.<\/jats:p>","DOI":"10.1177\/2045125320928167","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T01:42:53Z","timestamp":1590630173000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":31,"title":["Management of clozapine treatment during the COVID-19 pandemic"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1020-6777","authenticated-orcid":false,"given":"Siobhan","family":"Gee","sequence":"first","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK"},{"name":"Institute of Pharmaceutical Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Gaughran","sequence":"additional","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"MacCabe","sequence":"additional","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukhi","family":"Shergill","sequence":"additional","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6146-0073","authenticated-orcid":false,"given":"Eromona","family":"Whiskey","sequence":"additional","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK"},{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-1710","authenticated-orcid":false,"given":"David","family":"Taylor","sequence":"additional","affiliation":[{"name":"Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK"},{"name":"Institute of Pharmaceutical Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,5,27]]},"reference":[{"key":"bibr1-2045125320928167","unstructured":"World Health Organization [Internet], www.euro.who.int (accessed April 2020)"},{"key":"bibr2-2045125320928167","doi-asserted-by":"publisher","DOI":"10.1002\/j.2051-5545.2011.tb00036.x"},{"key":"bibr3-2045125320928167","unstructured":"Intensive Care National Audit and Research Centre. 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