How do you monitor patients who are symptomatically well-managed on clozapine with supratherapeutic drug levels?

I generally adhered to the published NIH guidelines (Correll et al., PMID 35759211).

It also looks like we will be changing everything pretty soon as these recommendations will change.

I still plan to do regular neutrophil and WBC counts, definitely not as frequently as previously recommended, but I would like to sleep well knowing that I do not kill anybody.

This isn’t totally speaking to your question, but maybe consider: Are they having side effects? What’s the heart rate like? Make sure that you’re monitoring constipation, not just ANC. Probably maintain the REMS monitoring schedule. Make sure that you’re aware of smoking status (of any substance) and changes to it. Consider an antiepileptic for safety. You might want to look into clozapine-fluvoxamine rational polypharmacy to reduce norclozapine levels and side effect burden while possibly maintaining therapeutic benefit at lower oral dosing, but it’s tricky to start and maintain.