Use Case 1
REMS-Gated ANC Monitoring Visit
Trigger: Scheduled clozapine clinic visit
1.Retrieve current ANC, prior ANC trend, BEN status, and monitoring frequency tier
2.Verify ANC ≥1500/µL (or ≥500/µL if BEN-confirmed) before continuation
3.Pull weight, fasting glucose, lipids, smoking status, and current dose
4.Screen for new medications affecting CYP1A2 or CYP3A4
5.Run constipation, hypersalivation, sedation, and seizure history checks
6.Generate visit summary with monitoring schedule and alerts
7.Trigger PharmD escalation if any threshold is breached
✓
REMS compliance enforced at every visit with comprehensive metabolic and adverse-effect surveillance.
Use Case 2
Absolute Contraindication / Hard Stop Screening
Trigger: Medication list change or smoking status change detected
1.Scan medication list for absolute contraindications (carbamazepine, other myelosuppressives)
2.Detect smoking status changes affecting CYP1A2 induction
3.Detect new agents with significant CYP1A2 or CYP3A4 effect
4.Issue HARD STOP for absolute contraindications and pause assessment
5.Escalate to PharmD with mechanism explanation and alternative options
6.Recommend serum level reassessment for CYP-affected interactions
7.Mark unstarted modules as 'skipped — hard stop'
✓
Absolute contraindications and CYP-mediated interactions caught before clinical harm.
Use Case 3
Bowel Obstruction Prevention Surveillance
Trigger: Every clozapine clinic visit
1.Ask about bowel movement frequency at every visit using explicit prompts
2.Flag any patient with no bowel movement in 3+ days as CRITICAL ALERT
3.Recommend immediate clinical review, abdominal exam, and possible imaging
4.Trigger aggressive bowel regimen (osmotic plus stimulant laxative)
5.Recommend holding clozapine if obstructive signs are present
6.Escalate to PharmD and PCP same-day
7.Document constipation findings and intervention plan
✓
Catastrophic clozapine-induced bowel obstruction prevented through systematic constipation surveillance.
Integrations
EHR / FHIR R4 API (Epic, Cerner, athenahealth)
Clozapine REMS Programme Portal
Lab Integration (CBC with differential, metabolic panel, troponin)
Drug Interaction Database (Lexicomp, First Databank)
PharmD Escalation Workflow
Clinical Document Generation (REMS audit reports, visit summaries)
Industries
healthcare
See It In Action
A sample conversation with this agent
ANC check for David Wright—clozapine 400mg daily, 18 months on therapy.
Pulling David's record. Today's ANC: 2,800/µL (well above the ≥1500/µL continuation threshold; no BEN flag in record). Last ANC 4 weeks ago: 3,100. He's now on monthly monitoring per the standard schedule (year 1+ stable). No concerning trend. Module 0 also pulled: smoking status unchanged, no new meds, weight up 4 lb in 90 days, fasting glucose 108 (up from 96 six months ago—early metabolic flag). Constipation screen: 'every other day, no straining.' Generating the visit summary. Recommend continuing 400mg daily, next ANC in 4 weeks. Flagging the metabolic trajectory for PharmD review.
His outpatient discharge summary says he's been taking carbamazepine for the last 2 weeks for trigeminal neuralgia.
HARD STOP. Carbamazepine is an absolute contraindication with clozapine—two compounding mechanisms: (1) CYP3A4 induction reduces clozapine plasma levels up to 50%, leading to potential symptom relapse; (2) carbamazepine itself carries agranulocytosis risk that compounds clozapine's. The combination has caused fatal agranulocytosis in published case reports. Action sequence: (1) escalating to PharmD now with the absolute contraindication flag, (2) recommending immediate alternative for the trigeminal neuralgia (gabapentin, or oxcarbazepine—lower agranulocytosis risk but still requires monitoring), (3) clozapine serum level recheck once carbamazepine is discontinued, with potential dose adjustment back up. Assessment paused—won't proceed with monitoring guidance until the carbamazepine is off.
He hasn't had a bowel movement in 4 days. Is this concerning?
CRITICAL ALERT. Clozapine-induced bowel obstruction is the most common cause of preventable clozapine-related death—and a 4-day BM gap on clozapine is a red flag, not a routine constipation report. The mechanism is severe anticholinergic-driven gut hypomotility that progresses silently to ileus, obstruction, perforation. Immediate actions: (1) urgent clinical review today, (2) abdominal exam for distension, tenderness, bowel sounds, (3) consider abdominal X-ray if any obstructive signs, (4) initiate aggressive bowel regimen (osmotic laxative + stimulant), (5) hold the next clozapine dose pending review, (6) escalate to PharmD with the constipation flag. Sending the alert to David's care manager and PCP now. Don't wait for the next scheduled visit.