Clozapine

Key points

• Clozapine: atypical antipsychotic for treatment-resistant schizophrenia.
• Agranulocytosis risk (~1%) → mandatory FBC monitoring: weekly for 18 weeks, then 2-weekly for a year, then 4-weekly.
• If neutrophils < 1.5 × 10⁹/l (or WCC < 3.0) → stop clozapine.
• Other side effects: hypersalivation, constipation (can be severe), myocarditis, seizures, weight gain.
• Smoking reduces clozapine levels (CYP1A2 induction) — dose adjustments needed if patient stops smoking.

Decision points in this pathway

• Neutrophils < 1.5 × 10⁹/l?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.