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Q.5: Patient with treatment resistant schizophrenia is initiated on Clozapine. During routing monitoring, ANC (Absolute Neutrophil Count) was found to be 900/μL. Patient had normal ANC of >1500/μL prior to Clozapine initiation. Which of the monitoring recommendations are correct as your next step?
(a) Once a week until ANC ≥ 1500/μL.
(b) Three times weekly until ANC ≥ 1500/μL.
(c) Two times weekly until ANC ≥ 1000/μL.
(d) Daily until ANC ≥ 1000/μL.
Patient have Moderate Neutropenia (500 - 999/μL).
ANC Monitoring for general population on clozapine with moderate neutropenia:
• Recommend hematology consultation.
• Interrupt treatment for suspected clozapine induced neutropenia.
• Resume treatment once ANC normalizes to ≥ 1000/μL
• Daily until ANC ≥ 1000/μL, then Three times weekly until ANC ≥ 1500/μL. Once ANC ≥ 1500/μL check ANC weekly for 4 weeks, then return to patient’s last “Normal Range” ANC monitoring interval.
Source: Clozapine REMS.
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