How do you decide who to rechallenge clozapine after it was discontinued for a neutropenic episode?

The clozapine rechallenge of the patient previously treated with clozapine but having it discontinued due to clozapine induced neutropenia or absolute neutropenia now has a sizable evidence-based literature suggesting that it can be done safely and successfully. Selecting patients with previous discontinuation due to neutropenia should be guided by prior good response of the psychiatric disorder to clozapine, absence of a suitable response to other antipsychotic medications since discontinuation of clozapine, and agreement of the patients or patients’ medical and psychiatric decision maker. The highest risk period after re-initiation is within the first 18 weeks and in the wake of discontinuation of the formal clozapine REMS program, weekly...

This isn’t a direct answer to the question as to who to rechallenge. It is related to it, though, in terms of tips on promoting neutrophilia when using clozapine or rechallenging with it. I treat teens and young adults who are neurologically and psychiatrically complex due to prenatal exposure to substances, trauma history, and intellectual developmental disorder. Clozapine has been a wonder drug for many of them for the treatment of psychosis, BPAD, BPD, etc. However, many have had very low neutrophil counts, frequently dropping under 1500 or 1000 on multiple occasions. I went searching for answers as to how to manage this. I learned that neutrophils have circadian release peaking in # in the evening and at a low ebb in the morning. Labs a...