Effectively Managing Clozapine for Treatment-Resistant Schizophrenia
In a series filmed at the 2025 NP Institute in Orlando, Hara Oyedeji, APRN, PMHNP-BC, MSEd, explores how Advanced Practice Providers (APPs) can best leverage antipsychotic interventions for the treatment of schizophrenia and treatment-resistant schizophrenia.
In Part 1 of this series, Oyedeji discusses how APPs can most effectively prescribe and monitor patient progress on clozapine, the only Food and Drug Administration (FDA)-approved treatment for treatment-resistant schizophrenia. Oyedeji dives into the clinical criteria and monitoring protocols clinicians should keep in mind as they track patient response to the medication and offers advice to APPs on becoming more comfortable using the intervention.
For more expert insights, visit the Schizophrenia Excellence Forum.
Read the Transcript
Hara Oyedeji, APRN, PMHNP-BC, MSEd: Hello, my name is Hara Oyedeji. I am a psychiatric nurse practitioner out of Baltimore, Maryland and I have my Master of Science in Nursing and also a Master of Science in Education, so I am an educator first and foremost. I have my own group practice, Fortitude Wellness Group, and I absolutely love being able to interact, teach, and work with fellow nurse practitioners.
Psych Congress Network: As the only FDA-approved treatment for treatment-resistant schizophrenia, what clinical criteria and monitoring protocols should APPs follow to initiate and manage clozapine safely and effectively?
Oyedeji: That's a great question, and it's something that I think newer nurse practitioners somewhat are intimidated by. I can understand—I remember when I was having to learn more about utilizing clozapine in practice. But I believe APPs really need to understand what treatment-resistant schizophrenia is and [that] clozapine definitely has a place [in its treatment]. It is the only FDA-approved treatment for treatment-resistant schizophrenia and, if you're going to utilize it, it's a wonderful option for those patients, but it does require you to have an understanding of getting those important labs; making sure that you're getting your baseline complete blood count (CBC), understanding, “Does my patient happen to be part of a benign ethnic neutropenic group?”, which are certain populations that inherently may have a higher threshold, but does not necessarily mean that, because they have a lower blood cell count, that they happen to be with neutropenia. So understanding that those things are important.
What the guidelines state when you're prescribing clozapine is that it requires you to do weekly monitoring. And that's a piece that might seem intimidating, but we really have to think about what our patients need, especially how they're presenting, and what their acuity level is. If you're dealing with treatment-resistant schizophrenia, [clozapine is] something that really needs to be in your toolkit. So understanding [it requires] weekly monitoring, getting those neutrophil counts, and then how long that's going to be—[every 2 weeks after the first 6 months, then monthly]—and then also thinking, how are you going to titrate? What is the dose that's going to be the most effective to treat the symptoms? You balance all of those things out.
But the only way to really get confidence in doing that is to practice, but of course, making sure you understand the guidelines and the parameters is very important with your lab monitoring.
Hara Oyedeji, APRN, PMHNP-BC, MSEd, is a board-certified psychiatric nurse practitioner currently working in outpatient care with experience in inpatient and psychiatric hospital settings. She serves as owner, clinician and clinical preceptor in her private group practice, Fortitude Wellness Group, and is the Chief Operating Officer and Medical Director of a CARF accredited Outpatient Mental Health Clinic, Greater Chesapeake Health and Wellness in Baltimore City. Hara completed her undergraduate degree at Rutgers University and her Master’s degree in education from Monmouth University in New Jersey. She completed her Master’s degree in nursing from the University of Maryland with her Post-Master's training as a psychiatric mental health nurse practitioner from Drexel University.
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