Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-06-19T13:38:13.243Z Has data issue: false hasContentIssue false
  • English
  • Français

Myocarditis and cardiomyopathy linked with clozapine treatment

Published online by Cambridge University Press:  13 June 2014

Sarah Prasad  and
Douglas R Bell
Sarah Prasad
Affiliation:
Department of Psychiatry, Beaumont Hospital, Dublin 9
Douglas R Bell
Affiliation:
Victorian Institute of Forensic Mental Health, Thomas Embling Hospital, Fairfield, Victoria 3078, Australia
Get access Rights & Permissions [Opens in a new window]

Abstract

Clozapine is associated with a risk of myocarditis and cardiomyopathy. The exact mechanisms still remains unclear although there have been a range of proposals ranging from hypersensitivity reactions, toxic effects of the drug to vitamin deficiency. We present three cases where there were minor deviations of heart function or structure prior to the onset of clozapine treatment. One case developed a mild rise in troponin-1 levels within one month of clozapine treatment. We also review the current literature on the link between clozapine, myocarditis and cardiomyopathy and suggest clinical guidelines for monitoring patients for cardiac symptoms prior to commencing and while on clozapine treatment.

Keywords

ClozapineMyocarditisCardiomyopathyTroponin-1
Type
Case Reports
Information
Irish Journal of Psychological Medicine , Volume 22 , Issue 4 , December 2005 , pp. 147 - 150
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Product Information, Clopine Connect Protocol Clopine® Product Information 2003Google Scholar
2.Meitzer, HY. Antipsychotics and anticholinergic drugs: New Oxford Textbook of Psychiatry, Volume 2, pp: 1314–1326.Google Scholar
3.Richelson, E. Neuroleptic affinities for human brain receptors and their use in predicting adverse effects: J Clin Psychiatry 1984; 45: 331–36.Google Scholar
4.Kane, J, Honigfeld, G, Singer, J, Meitzer, H and the Clozaril Collaborative Study Group: Clozapine for the treatment-resistant schizophrenic, a double blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–96.CrossRefGoogle Scholar
5.Conley, RR. Optimising treatment with clozapine. J Clin Psychiatry 1988; 59: (Suppl 3): 44–48.Google Scholar
6. Product Information: Clozapine Synthon 2002.Google Scholar
7.Kay, SEet al.Clozapine associated pericarditis and elevated troponin-I. Aust NZ J Psychiatry 2002; 36(1): 143–4.Google ScholarPubMed
8.Suttman, et al.Clozapine and sudden death. The Lancet 2000; 355(9206): 842–43.CrossRefGoogle Scholar
9.Coulter, DM, Bate, A, Meyboom, RH, Lindquist, M, Edwards, IR. Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study. BMJ 2001; 322(7296): 1207–9.CrossRefGoogle ScholarPubMed
10. Important Drug Safety Information Novartis, January 14 2002.Google Scholar
11.Killian, JG, Kerr, K, Lawrence, C, Celermajer, DS. Myocarditis and cardiomyopathy associated with clozapine. Lancet 1999; 354(9193):1841–5.CrossRefGoogle Scholar
12.Hagg, S, Spigset, O, Bate, A, Soderstrom, TG. Myocarditis related to clozapine treatment. J Clin Psychopharmacol 2001; 21(4): 382–388.CrossRefGoogle ScholarPubMed
13.La Grenade, L, Graham, D, Trontell, A. Myocarditis and Cardiomyopathy Associated with clozapine use in the United States. N Engl J Med 2001; 345(3): 224–5.CrossRefGoogle ScholarPubMed
14.Warner, B, Alphs, L, Schaedelin, J, Koestler, T. Clozapine and sudden death. Correspondence. Lancet 2000; 355(9206): 842.CrossRefGoogle Scholar
15.Vaddadi, KS, Soosai, E, Vaddadi, G. Low blood selenium concentrations in schizophrenic patients on clozapine. Br J Clin Pharmacol 2003; 55: 307–309.CrossRefGoogle ScholarPubMed
16.Alpert, JS, Thygesen, K, Antman, Eet al.Myocardial infarction redefined: a consensus document of the joint European society of cardiology/American college of cardiology committee for redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36: 959–69.Google Scholar
17.Apple, FS, Wu, AHB. Myocardial infarction redefined: role of cardiac troponin testing. Clin Chem 2001; 46: 377–379.CrossRefGoogle Scholar
18.Reid, P, McArthur, M, Pridmore, S. Clozapine rechallenge after myocarditis. Aust NZ J Psychiatry.Google Scholar
19.Brown, S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997; 171:502–08.CrossRefGoogle ScholarPubMed
20.Hagger, C, Buckley, P, Kenny, J, Freidman, L, Ubogy, D, Meitzer, H. Improvement in cognitive function and psychiatric symptoms in treatment-refractory schizophrenic patients receiving clozapine. Biol Psychiatry 1993; 34: 702–12.CrossRefGoogle ScholarPubMed
21.Wooltorton, E. Antipsychotic clozapine: myocarditis and cardiovascular toxicity. CMAJ 2002;166(9):1185–6Google ScholarPubMed
22.Howes, DS. Myocarditis. http://www.emedicine.com/EMERG/topic326.htm 2002.Google Scholar