To help EI teams adjust to the impact of the prescription viagra pandemic we have been gathering together policies, protocols and good practice that have been developed to support the maintenance of safe and effective services during the crisis. Please see the new COVID-19 section for national guidance and local example documents shared by EIP colleagues. We hope generic cialis fast shipping this will help you adapt quickly to these new challenges and help you to provide the best care possible during this extraordinary period.

By Ann and David Shiers, 20th April 2020

Now in her 40s, our daughter enjoys life and is supported in an excellent residential care home. However she experiences severe psychological impairments, due to a combination of schizophrenia and learning disability. She requires support with all aspects of her life.

What if our daughter couldn’t complete her routine blood count? Maybe she’s had to self-isolate? Maybe the system had a canadian healthcare viagra temporary glitch? But whatever the cause, an absent ‘green’ blood test could result in our daughter’s clozapine being withheld.

Current product licensing rules. Because she has been on clozapine without evidence of suppressed white cell counts for cheap levitra on line more than 12 months then the current product licence permits a two-week extension. Beyond that, the prescribing doctor must take responsibility for prescribing outside the manufacturer’s product licence.

Are we reassured by the offer of blood sampling being taken in her residential home? NO! Would she accept a stranger in gown and mask coming to her home to take blood? It’s right OUTSIDE HER ROUTINE and she would almost certainly REFUSE.

Here’s what scares us. Vivid and painful memories of three years of incarceration in hospital following onset of psychosis in late teens. Drug after drug tried. Rock bottom. Nothing helped until clozapine was commenced. And now:
⦁ 23 years on clozapine without a single unsatisfactory routine blood test.
⦁ 23 years without a relapse of her psychosis
⦁ 23 years clawing back a life worth living

A balance of risks. Sacrificing 23 years of stability on clozapine and the horrendous risk of a relapse into hospital and then god knows what that might lead to in the longer term.  All because Covid-19 indirectly impeded routine blood testing.

Concerns from families like ours are being recognised. Take a look at the latest advice on clozapine from some notable national authorities:

⦁ Maudsley guidance on Covid-19 and clozapine

⦁ Rethink – Coronavirus and Clozapine

⦁ NHS Specialist Pharmacy Service – Clozapine monitoring during Covid-19

We shared our concerns with a psychiatrist friend. His view was “Where there’s a will there’s a way. With a flexible, collaborative and personalised approach involving patient, carers, clinicians & pharmacists I would be optimistic that this risk can be successfully navigated to ensure continuity of treatment”.

How does your service balance this clozapine and Covid-19 risk in these strange and worrying times?

POSTSCRIPT (May 11th): SEE CLOZAPINE PRESCRIBING RESOURCE

from Tees, Esk and Wear Valleys NHS Foundation Trust