A 28-year-old man with schizophrenia has been on clozapine 400 mg/day for 6 months. His absolute neutrophil count (ANC) drops to 900/mm³. According to current REMS monitoring guidelines, the most appropriate next step is:
- A Stop clozapine immediately and switch to olanzapine
- B Interrupt clozapine, monitor ANC daily; rechallenge when ANC ≥1000/mm³ ✓
- C Continue clozapine and recheck ANC in 1 week
- D Reduce clozapine dose to 200 mg/day and recheck in 3 days
Correct answer: B. Interrupt clozapine, monitor ANC daily; rechallenge when ANC ≥1000/mm³
Explanation
An ANC of 900–999/mm³ represents mild neutropenia (formerly 'yellow alert'). Current clozapine REMS guidance requires interruption of the drug, daily ANC monitoring, and rechallenge is permitted once ANC recovers to ≥1000/mm³. Permanent discontinuation is mandated only if ANC falls below 500/mm³ (severe neutropenia). Simply continuing the drug or reducing the dose without interruption would be unsafe at this ANC level.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.