Absolute neutrophil count and adverse drug reaction monitoring during clozapine treatment: consensus guidelines from a global Delphi panel
Date
2025
Authors
Siskind, D.
Northwood, K.
Pillinger, T.
Chan, S.
Correll, C.
Cotes, R.O.
Every-Palmer, S.
Hahn, M.
Howes, O.D.
Kane, J.M.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
The Lancet Psychiatry, 2025; 1-10
Statement of Responsibility
Dan Siskind, Korinne Northwood, Toby Pillinger, Sherry Chan, Christoph Correll, Robert O. Cotes, Susanna Every-Palmer, Maggie Hahn, Oliver D. Howes, John M Kane, Deanna Kelly, Nicole Korman, Julia Lappin, Cristián Mena, Nick Myles, the Clozapine Delphi Expert Panel (Dan Siskind ... Scott R Clark ... et al.), Robert A. McCutcheon
Conference Name
Abstract
Despite its superior effectiveness for treatment-resistant schizophrenia, clozapine has a high burden of adverse drug reactions (ADRs), which require monitoring and treatment. This global Delphi study has established consensus guidelines for absolute neutrophil count (ANC) thresholds for consideration of clozapine cessation and provided monitoring protocols for ADR management. Recommendations include lowering ANC thresholds for consideration of clozapine cessation to 1·0 × 10⁹ cells per L (0·5 × 10⁹ cells per L for Duffy antigen receptor for chemokines-null individuals) and discontinuing routine ANC monitoring after 2 years. Comprehensive ADR monitoring, with ANC monitoring in the first 2 years, then every 3 months after discontinuing routine ANC monitoring, should address the metabolic syndrome, constipation, gastro-oesophageal reflux, sialorrhea, nocturnal enuresis, tachycardia, sleep apnoea, sedation, and other ADRs. Consumer representatives underscored the need for shared decision-making, streamlined monitoring, and accessible patient education. Although barriers persist, these findings support updating global policies to reduce burden on patients, enhance adherence, and optimise clinical outcomes. Incorporating evidence-based guidelines into practice could transform clozapine care, balancing safety with practicality to improve the lives of those with treatment-resistant schizophrenia
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Description
Position Paper.
Published Online 2 July 2025.
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Copyright © 2025. Elsevier Inc. All rights reserved. For personal use only. No other uses without permission.