Conclusion Regular blood tests for lithium are important. Lithium is known to have significant side effects and requires close serum level monitoring to ensure levels remain within the therapeutic range to minimize the risk of serious adverse effects or toxicity. Ensuring that these monitoring tests occur as well as supplying information to patients prescribed lithium is a priority for all healthcare organizations where lithium therapy is initiated, prescribed, dispensed and monitored [NPSA, 2009]. Since the database was started in Norfolk there has been a steady increase in the number of people receiving the lithium, renal and thyroid function

Inhibitors,research,lifescience,medical tests recommended by NICE [NICE, 2006]. There have also been no incident reports in Norfolk since the initiation of the database, suggesting safe prescribing of lithium. Footnotes Funding: This research received no specific grant from Inhibitors,research,lifescience,medical any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest statement: The authors declare no conflicts of interest in preparing this article. Contributor Information Emma Kirkham, School of Pharmacy, University of East Anglia, Norwich Research Park, Norfolk Inhibitors,research,lifescience,medical NR4 7TJ, UK. Stephen Bazire, Norfolk and Suffolk

NHS Foundation Trust, selleck Hellesdon Hospital, Norwich, UK. Timothy Anderson, Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK. John Wood, School of Life and Medical Sciences, Institute of Epidemiology and Health Care, University College London, London, UK. Paul Grassby, School of Life Sciences, University of Lincoln, Lincoln, UK. James A. Desborough, School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK.
Clozapine is a dibenzodiazepine known for its lesser extrapyramidal side Inhibitors,research,lifescience,medical effects compared with other antipsychotic medications. It is a second-line antipsychotic drug used in treatment-resistant psychosis, refractory mania, psychosis in mental subnormality, borderline personality

and other conditions Inhibitors,research,lifescience,medical such as suicidality in psychotic patients [Meltzer et al. 1995; Raja, 2011]. Several case studies have shown various life-threatening side effects of clozapine, ranging Tryptophan synthase from haematological (agranulocytosis), cardiac (cardiomyopathies, pericarditis), nervous (seizure), metabolic (diabetes, dyslipidaemia) and gastrointestinal (haematemesis, constipation, oesophagitis) complications [Fitzsimons et al. 2005; Drugs.com, 2012]. A review of the mortality effect of clozapine showed that it lowers the mortality rate in severe schizophrenia by decreasing suicide rates, while the mortality rate for less common causes of death, such as pulmonary embolism and cardiac problems, is higher [Walker et al. 1997]. Reported gastrointestinal side effects of clozapine are oesophagitis, constipation and bowel ischaemia [Laker and Cookson, 1997; Townsend and Curtis, 2006; Rege and Lafferty, 2008].