A case of spontaneous resolution of myocarditis in a schizophrenic patient treated with clozapine without treatment discontinuation

Wang, Jay Ching-Chieh; Mihic, Tamara; Fennemore, Marie

doi:10.1016/j.ajp.2018.04.031

Cited by 2 publications

(3 citation statements)

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“…There have been published cases where myocarditis has resolved despite continuation of clozapine. 15,16 As there are no tests available to differentiate infectious versus drug-induced myocarditis, in some of these cases, clozapine discontinuation may not have been necessary due to another plausible aetiology for the condition. Determining which patients require immediate cessation of the drug rather than continuation with careful monitoring is an ongoing clinical dilemma.…”

Section: Discussionmentioning

confidence: 99%

“…5 It is believed that clozapine should be permanently discontinued in patients who have experienced myocarditis, although there are some case reports of successful rechallenge in selected patients and cases where myocarditis has resolved spontaneously without discontinuation of the medication. [15][16][17] St. Paul's Hospital (SPH) is a large tertiary hospital that serves an inner-city population and has 4 general, inpatient mental health units with 60 beds. Preprinted order sets and a monitoring algorithm for neutropenia/agranulocytosis and myocarditis were implemented in 2015 (see Supplemental Figure S1), adapted from a protocol published by Ronaldson et al 7 based on expert consensus.…”

Section: Abstract Clozapine Myocarditis Adverse Drug Reactionmentioning

confidence: 99%

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confidence: 99%

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Incidence and Management of Clozapine-Induced Myocarditis in a Large Tertiary Hospital

et al. 2019

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Objective: Clozapine, an antipsychotic reserved for management of treatment-resistant schizophrenia, is associated with severe adverse effects, including myocarditis. This study aims to determine the incidence of clozapine-induced myocarditis at a large tertiary hospital compared to what is reported in the literature. Methods: Medical records of adult patients admitted to psychiatry units receiving clozapine between January 1, 2010, and July 31, 2016, were retrospectively reviewed. Cases of clozapine-induced myocarditis were defined as having elevated C-reactive protein (CRP) or detectable troponin and at least 1 sign or symptom of myocarditis, in the absence of alternative plausible aetiologies. The primary outcome was incidence of clozapine-induced myocarditis during the study period. Secondary outcomes included rate and description of the management of clozapine-induced myocarditis. Results: In total, 316 patients were screened; 10 patients met the case definition for clozapine-induced myocarditis. The incidence of this adverse drug reaction over the study period was 3.16%. Reduced left ventricular ejection fraction was observed in 60% of cases, and electrocardiography changes were noted in 60% of cases. Clozapine was discontinued in all cases. Rechallenge was performed in 2 patients; recurrent CRP elevation resulted in discontinuation in each case. Medications for management of myocarditis were used in 50% of cases. Although 2 patients required transfer to critical care, the in-hospital mortality rate was 0%. Conclusions: The incidence of clozapine-induced myocarditis at the study hospital was consistent with the higher range reported in the literature. Further research is necessary to elucidate risk factors, definitive diagnostic criteria, and effective management of clozapine-induced myocarditis. Abré gé Objectif : La clozapine, un antipsychotique réservé à la prise en charge de la schizophrénie réfractaire au traitement, est associée à des effets indésirables graves, dont la myocardite. Cette étude vise à déterminer l'incidence de la myocardite induite par clozapine dans un grand hô pital de soins tertiaires comparativement à ce que déclare la littérature.

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Section: Discussionmentioning

confidence: 99%