What is a critical consideration when prescribing clozapine and what monitoring is required?

• A. Risk of agranulocytosis; requires regular ANC monitoring and infection surveillance per protocol.
• B. No special monitoring is required.
• C. Monitor only liver enzymes.
• D. Monitor only for weight changes.

Answer: (A)

Clozapine carries a substantial risk of agranulocytosis, a dangerous drop in neutrophils that can lead to life-threatening infections. The essential consideration when prescribing is implementing strict ANC monitoring and infection surveillance according to a formal protocol. Patients begin with frequent ANC checks during the early treatment phase, with intervals extended only as counts remain stable. If ANC falls below the protocol threshold, the medication is paused or stopped to prevent a serious neutropenic event. In addition to ANC monitoring, clinicians educate patients to report fever, sore throat, or signs of infection promptly and monitor for other known risks like myocarditis and metabolic effects. Other monitoring such as liver enzymes or weight changes, while useful for overall care, do not address the key safety issue posed by clozapine.