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Clozapine Extended Monitoring — MRCPsych Paper B MCQ

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HardSchizophrenia & PsychosisClozapine Extended MonitoringMRCPsych Paper B

A 45-year-old man with treatment-resistant schizophrenia has taken clozapine continuously for 8 years. His neutrophil counts have remained stable, and he currently undergoes haematological monitoring every 4 weeks. His clinical team notes recent UK observational evidence suggesting that 12-weekly monitoring may be safe in selected long-term patients. According to current UK official monitoring requirements, which approach should be taken?

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Correct answer: E — Continue monitoring at intervals no longer than 4 weeks

The correct answer is E. Current UK Clozaril official recommendations require differential white-cell and neutrophil monitoring at least every 4 weeks after one year of treatment with stable results, continuing throughout treatment. Recent UK observational evidence found no agranulocytosis among 1,025 selected long-term patients monitored every 12 weeks, but this supports possible future regulatory change rather than superseding current UK requirements. Therefore C is an evidence-informed proposal, not routine authorised UK practice. Monitoring cannot be stopped or reduced to six-monthly intervals, excluding B and E. Weekly monitoring is used during initiation or following specified treatment interruptions or abnormal results, not indefinitely in this stable patient, excluding A.

Reference: Clozapine Viatris, Clozaril 100 mg Tablets Summary of Product Characteristics, UK Clozaril Official Recommendations and section 4.4, revised February 2026. https://www.medicines.org.uk/emc/product/15498/smpc