Time for a change to clozapine haematological monitoring

Objectives This paper critiques the haematological monitoring guidelines for clozapine. It describes the history of clozapine, as well as the pathophysiology and epidemiology of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA). The paper appraises the extant literature on mandatory cloz...

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Bibliographic Details
Published in:Australasian psychiatry : bulletin of the Royal Australian and New Zealand College of Psychiatrists 2024-08, Vol.32 (4), p.342-345
Main Authors: Cheng, Adrian, Buten, Sara, Large, Matthew
Format: Article
Language:English
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Summary:Objectives This paper critiques the haematological monitoring guidelines for clozapine. It describes the history of clozapine, as well as the pathophysiology and epidemiology of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA). The paper appraises the extant literature on mandatory clozapine haematological monitoring. Conclusion Contemporary Australian protocols for clozapine haematological monitoring are not consistent with the current evidence base. CIN and CIA are rare occurrences, and the associated risk of death is low. Potential modifications to existing guidelines include changing neutrophil thresholds for patients with benign ethnic neutropenia and reducing the frequency or removing haematological monitoring after two years of clozapine treatment.
ISSN:1039-8562
1440-1665
1440-1665
DOI:10.1177/10398562241258764