Clozapine remains the only drug treatment likely to benefit patients with treatment resistant schizophrenia. Its use is complicated by an increased risk of neutropenia and so there are stringent monitoring requirements and restrictions in those with previous neutropenia from any cause or from clozapine in particular. Despite these difficulties clozapine may yet be used following neutropenia, albeit with caution. Having had involvement with 14 cases of clozapine use in these circumstances we set out our approach to the assessment of risks and benefits, risk mitigation and monitoring with a practical guide.
Keywords: *Neutrophils.; Agranulocytosis/drug therapy*; Antipsychotic Agents/administration & dosage/*adverse effects.; Clozapine.; Clozapine/*adverse effects.; Forensic mental health services.; Granulocyte-Colony-Stimulating Factor/*therapeutic use.; Lithium/*therapeutic use.; Neutropenia/blood/chemically induced/ethnology/*therapy.; Schizophrenia/drug therapy*..