Dear Editor, Few studies examine the use of clozapine in rural and remote locations, or in First Nations Peoples. Despite efficacy in treatment resistant schizophrenia, the risk of haematological, cardiac and metabolic dysfunction can often be an impediment to clozapine initiation (Leucht et al., 2013). This presents an issue for those in rural locations with reduced access to psychiatric services (Hunter et al., 2011; Gynther et al., 2019). Our previous work has highlighted the difficulties in clozapine continuation, with over half ceasing within five years in Far North Queensland (FNQ) (Bridson et al., 2020). Here we address the metabolic complications associated with clozapine administration in this area.