👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Pharmacological Therapies🔖 Free to read, print, and share
Also known as: Clozaril · atypical antipsychotic · second-generation antipsychotic
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Use this quick-reference guide to spot, treat, and prevent Clozapine on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Use
Treatment-resistant schizophrenia
Last-line atypical
🧪 Labs
Weekly ANC/WBC monitoring
Hold if ANC < 1500
REMS program required
🚩 Report
Fever, sore throat, infection
Myocarditis → chest pain
Seizures at high doses
🩺 Signs
Hypersalivation (drooling)
Weight gain, sedation
📚 Clozapine — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Clozapine is an atypical (second-generation) antipsychotic reserved for treatment-resistant schizophrenia and for reducing suicidality in schizophrenia. It is highly effective but carries a serious risk of agranulocytosis, requiring mandatory ANC monitoring through a REMS program. It also lowers the seizure threshold and can cause myocarditis. Memory aid: Clozapine = mandatory blood counts.
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Key points
Understand these first
Risk of agranulocytosis (severe neutropenia) requires regular ANC monitoring under a REMS program before dispensing.
Reserved for treatment-resistant schizophrenia and to reduce suicide risk in schizophrenia.
Lowers the seizure threshold (dose-related seizures) and can cause myocarditis and cardiomyopathy.
Causes significant sedation, hypersalivation (drooling), weight gain, and metabolic syndrome.
Carries risk of orthostatic hypotension and constipation (can progress to bowel obstruction).
Has a low rate of EPS compared with typical antipsychotics.
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Nursing priorities
What to do, in order
Ensure ANC/WBC is checked on schedule and within range before each dispense (REMS).
Monitor for signs of infection (fever, sore throat, flu-like symptoms) indicating agranulocytosis.
Assess for seizures, signs of myocarditis (chest pain, dyspnea, tachycardia), and constipation.
Monitor weight, glucose, and lipids for metabolic syndrome.
Teach the patient to never miss blood draws or doses without provider guidance.
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Red flags — report now
Escalate immediately
Fever, sore throat, or signs of infection - possible agranulocytosis, hold and report immediately.
Chest pain, dyspnea, tachycardia, or unexplained fatigue - possible myocarditis.
Seizures.
Severe constipation/no bowel movement - risk of paralytic ileus.
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Labs & values
Numbers to know
ANC at least 1,500/mcL required to continue (lower thresholds for benign ethnic neutropenia)
WBC 5,000-10,000/mcL (monitored per REMS)
Fasting glucose and lipid panel (metabolic monitoring)
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Patient teaching
What patients must know
You must have your blood counts drawn regularly; you cannot get the medication without it.
Report fever, sore throat, or any infection signs right away.
Report chest pain, shortness of breath, or fast heartbeat - and any seizures.
Increase fiber and fluids for constipation; rise slowly to prevent dizziness.
❓ Clozapine: NCLEX FAQs
What are the priority nursing interventions for Clozapine?
Ensure ANC/WBC is checked on schedule and within range before each dispense (REMS). Monitor for signs of infection (fever, sore throat, flu-like symptoms) indicating agranulocytosis. Assess for seizures, signs of myocarditis (chest pain, dyspnea, tachycardia), and constipation. Monitor weight, glucose, and lipids for metabolic syndrome.
What are the warning signs of Clozapine a nurse must report?
Fever, sore throat, or signs of infection - possible agranulocytosis, hold and report immediately. Chest pain, dyspnea, tachycardia, or unexplained fatigue - possible myocarditis. Seizures. Severe constipation/no bowel movement - risk of paralytic ileus.
What do I need to know about Clozapine for the NCLEX?
Risk of agranulocytosis (severe neutropenia) requires regular ANC monitoring under a REMS program before dispensing. Reserved for treatment-resistant schizophrenia and to reduce suicide risk in schizophrenia. Lowers the seizure threshold (dose-related seizures) and can cause myocarditis and cardiomyopathy. Causes significant sedation, hypersalivation (drooling), weight gain, and metabolic syndrome.
What patient teaching is important for Clozapine?
You must have your blood counts drawn regularly; you cannot get the medication without it. Report fever, sore throat, or any infection signs right away. Report chest pain, shortness of breath, or fast heartbeat - and any seizures. Increase fiber and fluids for constipation; rise slowly to prevent dizziness.
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Quick Tip
Risk of agranulocytosis (severe neutropenia) requires regular ANC monitoring under a REMS program before dispensing.