Pharmacists' role in clozapine therapy at a Veterans Affairs medical center

A program in which pharmacists have an active role in prescribing and dispensing psychoactive drugs is described. The Department of Veterans Affairs (VA) has established a National Clozapine Coordinating Center (NCCC) that must approve all clozapine therapy in VA medical centers. Clinical and demographic information is required for all new patients, and weekly status reports are required throughout clozapine therapy. To comply with NCCC requirements, pharmacists with specialized training in psychopharmacology organized a clozapine clinic at one VA medical center, in conjunction with the psychiatry service. The pharmacists screen potential candidates for clozapine therapy and forward the required information to the NCCC for approval. During treatment, they ensure that necessary laboratory tests and clinical evaluations are performed for inpatients and recommend dosage adjustments to the psychiatry residents. The pharmacists see outpatients receiving clozapine weekly to monitor and record vital signs, laboratory results, and response to therapy and make dosage adjustments accordingly. For both inpatients and outpatients, the pharmacists send weekly patient evaluations to the NCCC. Pharmacists at a VA medical center provide direct care to patients receiving clozapine and help their institution comply with the stringent therapy-monitoring requirements of the NCCC.