Explanation

Clozapine is the most effective medication for treatment-resistant schizophrenia but carries significant risks that require thorough informed consent. The most serious risk is agranulocytosis, a potentially fatal drop in white blood cells that necessitates regular absolute neutrophil count (ANC) monitoring per the prescribing information (the Clozapine REMS enrollment program was eliminated in 2025). Other significant risks include metabolic syndrome (weight gain, diabetes, dyslipidemia), myocarditis (especially in the first month), dose-dependent seizure risk, significant sedation, and orthostatic hypotension. When a patient directly asks about risks, the PMHNP should respond honestly and completely while balancing the discussion with information about benefits and the purpose of monitoring protocols. This balanced approach supports informed decision-making without either minimizing risks or creating unnecessary alarm.

Key Takeaway

Informed consent for high-risk medications requires balanced, honest disclosure of both risks and benefits.