Table 6.

Clozapine treatment recommendations based on absolute neutrophil count monitoring for the general patient population [62]

ANC level	Treatment recommendations	ANC monitoring
Normal range (≥ 1,500/μL)	Initiate treatment If treatment interrupted: ≤ 30 days, continue monitoring as before ≥ 30 days, monitor as if new patient	Weekly from initiation to 6 months Every 2 weeks from 6 to 12 months Monthly after 12 months
Mild neutropenia (1,000–1,499/μL)a	Continue treatment; consider low-dose lithium augmentation to increase white cell count	Three times weekly until ANC ≥ 1,500/μL Once ANC ≥ 1,500/μL, return to patient’s last “normal range” ANC monitoring intervalb
Moderate neutropenia (500–999/μL)a	Recommend hematology consultation Interrupt treatment for suspected clozapine induced neutropenia Resume treatment once ANC ≥ 1,000/μL; consider low-dose lithium augmentation to increase white cell count	Daily until ANC ≥ 1,000/μL, then Three times weekly until ANC ≥ 1,500/μL Once ANC ≥ 1,500/μL, check ANC weekly for 4 weeks, then return to patient’s last “normal range” ANC monitoring intervalb
Severe neutropenia (< 500/μL)a	Recommend hematology consultation Interrupt treatment for suspected clozapine-induced neutropenia Do not rechallenge unless prescriber determines benefits outweigh risks	Daily until ANC ≥ 1,000/μL, then Three times weekly until ANC ≥ 1,500/μL If patient rechallenged, resume treatment as a new patient under “normal range” monitoring once ANC ≥ 1,500/μL

ANC absolute neutrophil count, BEN benign ethnic neutropenia

^aConfirm all initial reports of ANC less than 1,500/μL with a repeat ANC measurement within 24 h

^bIf clinically appropriate

This table was adapted from the FDA document "HIGHLIGHTS OF PRESCRIBING INFORMATION - CLOZARIL®”, copyright HLS Therapeutics (USA), Inc. Any changes made to the table are not endorsed by HLS Therapeutics (USA), Inc. CLOZARIL® is a registered trademark of Novartis Pharmaceuticals Corporation [62]