A client in the second month of clozapine therapy reports a temperature of 38.3°C (100.9°F) and a sore throat. Which action should the nurse take?
1Arrange prompt clinical evaluation, notify the prescriber, and anticipate an absolute neutrophil count.✓ Correct answer
2Reassure the client that fever is expected during early clozapine therapy and schedule a routine visit.
3Explain that blood-count monitoring is no longer needed because the Clozapine REMS was removed.
4Advise the client to take aspirin and continue clozapine without contacting the treatment team.
Explanation
Clozapine can cause severe neutropenia, and fever with sore throat requires prompt evaluation for infection and an absolute neutrophil count. The FDA removed the Clozapine REMS effective June 13, 2025, but the neutropenia risk remains and ANC monitoring continues according to prescribing information. The nurse should not reassure the client, delay evaluation, or recommend self-treatment while clozapine is continued without prescriber review.
Current safety update The federal Clozapine REMS and mandatory ANC reporting were removed in 2025. That administrative change did not remove the drug's severe-neutropenia risk.
Decision rule Fever, sore throat, mouth ulcers, or other infection symptoms during clozapine therapy require prompt clinical assessment and ANC evaluation according to the current prescribing plan.
Scenario A 28-year-old male with treatment-resistant schizophrenia has failed adequate trials of olanzapine and risperidone. The provider prescribes clozapine 12.5 mg PO BID with a planned titration. REMS program enrollment is complete and the pharmacy is awaiting clearance to dispense.
Clozapine-associated neutropenia — A potentially severe reduction in neutrophils that can lead to serious infection; risk is greatest early in therapy but persists throughout treatment.
ANC monitoring after REMS removal — The U.S. Clozapine REMS was removed in 2025, but prescribers should continue ANC monitoring according to current prescribing information.
Treatment-resistant schizophrenia — Schizophrenia that has failed adequate trials of at least two other antipsychotics; clozapine is uniquely effective and is the recommended next-line agent.