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Clozapine Metabolic Monitoring Schedule — MRCPsych Paper B MCQ

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HardSchizophrenia & PsychosisClozapine Metabolic Monitoring ScheduleMRCPsych Paper B

A patient with treatment-resistant schizophrenia is about to start clozapine. Which schedule most accurately describes the glycaemic component of clozapine-specific metabolic monitoring used in current UK practice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — HbA1c or plasma glucose at baseline, plasma glucose at 1 month, then HbA1c or plasma glucose every 4–6 months

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

B is correct. Clozapine has substantial metabolic liability, and the clozapine-specific glycaemic schedule comprises HbA1c or plasma glucose at baseline, plasma glucose at 1 month, and HbA1c or plasma glucose every 4–6 months thereafter. Option C reproduces the generic NICE schedule for antipsychotics—testing at 12 weeks, 1 year and annually—but does not capture the more intensive clozapine-specific approach. Option D resembles the clozapine lipid-monitoring schedule used in some NHS protocols rather than the glycaemic schedule. Options A and E omit continuing 4–6-monthly surveillance. Additional testing is required when results are abnormal, symptoms of hyperglycaemia occur, or established diabetes requires closer individualised monitoring.

Reference: Gloucestershire Health and Care NHS Foundation Trust. Clozapine Policy, version 5.1, Action Card 8: Clozapine—physical health monitoring requirements and frequency. 2025/2026. https://foi.ghc.nhs.uk/wp-content/uploads/2026/02/5.8-CLP265-Clozapine-Policy-V5.1-issued-16.12.25.pdf