Integrating clozapine into PD services: Insights from a single neurosciences centre, North- East England

<h3>Background</h3> Parkinson’s disease psychosis (PDP) is a common complication of PD, associated with high morbidity and mortality, and contributing to caregiver burnout. Managing PDP is challenging as most antipsychotics worsen motor function. Clozapine is a gold standard antipsychotic, effectively treats PDP without motor symptoms aggravation. However, its use is limited by agranulocytosis risk, necessitating frequent blood count monitoring. We provide an overview of Clozapine service experience in PASU (Parkinson’s Advanced Symptoms Unit); James cook university Hospital (JCUH). <h3>Results</h3> In PASU services, 1,500 Parkinson’s disease (PD) patients have been tracked, and Clozapine was integrated into the service in 2016. From 2016 to November 2023, 33 PD patients commenced Clozapine, averaging 2-6 patients annually. The average duration of PD diagnosis before starting Clozapine was 10.45 years, with doses ranging from 6.25mg to 125mg and a mean dose of 35.42mg; 97% began at 6.25mg. Visual hallucinations (91%) primarily led to Clozapine initiation, with 82% experiencing documented symptoms improvement. While 42% encountered side effects like drowsiness and constipation, only 12% discontinued Clozapine due to intolerable effects, and no cases of agranulocytosis were reported. <h3>Conclusion</h3> Drawing from our experience, Clozapine proves well-tolerated and effective antipsychotic in PDP, highlighting its excellent integration into PD services.