Published: 24 August 2026

Consultations

Outcome of the consultation on changes to clozapine blood monitoring and prescribing requirements

Summary

  • Medsafe consulted on changes to clozapine blood monitoring and prescribing restrictions.
  • We received 122 responses to the consultation for healthcare professionals.
  • Download the consultation outcome document (PDF, 1.23 MB, 41 pages) to view the consultation feedback, Medsafe’s response and the final blood monitoring requirements and prescribing restrictions.
  • We also received 10 responses to a separate consultation for consumers and families.
  • Download the consultation outcome document (PDF, 214 KB, 8 pages) to view the consultation feedback from consumers and families.
  • We expect to implement the changes to the clozapine blood monitoring requirements and prescribing restrictions in March 2027.

About the consultation

From August to October 2025, Medsafe sought feedback on proposed changes to the blood monitoring and prescribing requirements for clozapine. We conducted this consultation on behalf of the companies that distribute clozapine-containing medicines in New Zealand.

Clozapine is an antipsychotic medicine indicated for treatment-resistant schizophrenia. To increase the safety of people taking clozapine, there are restrictions on use of the medicine in New Zealand. In some people, clozapine can cause neutropenia (a reduction in neutrophils, a type of white blood cell), increasing the risk of severe infections. Currently, patients taking clozapine must have regular blood tests throughout treatment to check for neutropenia. 

Medsafe has reviewed the clozapine blood monitoring requirements, and we have identified several opportunities to optimise them. With the expanded roles of some healthcare professions, we also sought feedback on who should initiate clozapine treatment, and which prescribers can continue clozapine treatment.

We proposed four major changes to the clozapine blood monitoring requirements.

  1. Duration of blood monitoring
  2. Monitoring thresholds
  3. Management of low blood count results (‘red’ results)
  4. Who can prescribe clozapine.

We also sought feedback about Point-of-Care testing and educational needs for healthcare professionals. 

Submissions received

There were 122 responses to the consultation for healthcare professionals. Respondents included psychiatrists, GPs, nurses, nurse practitioners, pharmacists, pharmacist prescribers, professional bodies and other healthcare professionals.

Most respondents agreed that there should be changes to the clozapine blood monitoring requirements and prescribing restrictions.

You can view the submissions from healthcare professionals that we have permission to publish.

There were also 10 responses to a separate consultation for consumers and families.

You can view the submissions from consumers and families that we have permission to publish.

Outcome

There will be an option for patients to stop mandatory monthly blood monitoring after a period of 2 years of continuous treatment, if they meet certain eligibility criteria. Blood monitoring thresholds and management of low ANC results (‘red’ results) will change. The clozapine blood monitoring databases and clozapine data sheet will be updated.

The restrictions on who can prescribe clozapine will be updated. For example, nurse practitioners and pharmacist prescribers will be able to continue clozapine prescribing.

The information above is only a brief summary of the consultation outcome. For the full consultation feedback and Medsafe’s response, please download the consultation outcome documents.

Implementation date

We expect to implement the changes to the clozapine blood monitoring requirements and prescribing restrictions in March 2027.

Enquiries

For any questions about this consultation, please email: medsafeadrquery@health.govt.nz.

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