2018
DOI: 10.3389/fnins.2018.00203
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Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

Abstract: Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these.Objective: This systematic review summarizes the literature on autonomic dysfunction and relat… Show more

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Cited by 60 publications
(45 citation statements)
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References 151 publications
(248 reference statements)
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“…Haloperidol (with stronger dopaminergic effects) via the intravenous route showed an increased risk of QT prolongation. Similar arrhythmias have been demonstrated with thioridazine and chlorpromazine (with stronger effects on adrenergic and cholinergic systems), but also clozapine, quetiapine, olanzapine, risperidone -SGAs of last generation 18 . In some cases, the association between antipsychotics and other medication, such as pantoprazole, ciprofloxacin or antidepressants, increased the torsadogenic risk 19 .…”
Section: Qt Prolongation and Arrhythmiassupporting
confidence: 67%
“…Haloperidol (with stronger dopaminergic effects) via the intravenous route showed an increased risk of QT prolongation. Similar arrhythmias have been demonstrated with thioridazine and chlorpromazine (with stronger effects on adrenergic and cholinergic systems), but also clozapine, quetiapine, olanzapine, risperidone -SGAs of last generation 18 . In some cases, the association between antipsychotics and other medication, such as pantoprazole, ciprofloxacin or antidepressants, increased the torsadogenic risk 19 .…”
Section: Qt Prolongation and Arrhythmiassupporting
confidence: 67%
“…Relief of stress may also have a beneficial effect on cardiovascular mortality. Smoking and high blood pressure are among the most important risk factors for cardiovascular death, and antipsychotics, especially clozapine, decrease blood pressure and possibly also the rate of smoking.…”
Section: Discussionmentioning
confidence: 99%
“…However, it is possible that their untrained status may have led to a physiological impairment and lower HR peak , as observed with, for example, advancing age . Moreover, it could also be explained by the use of second‐generation antipsychotics, such as clozapine, which increases adrenergic activity and heart rate during rest and may cause autonomous dysregulation . The low V̇O 2peak observed in patients with schizophrenia may also be explained by cigarette smoking.…”
Section: Discussionmentioning
confidence: 99%
“…20,30 Moreover, it could also be explained by the use of second-generation antipsychotics, such as clozapine, which increases adrenergic activity and heart rate during rest and may cause autonomous dysregulation. 31 The low VȮ 2peak observed in patients with schizophrenia may also be explained by cigarette smoking. However, despite that more male patients were smokers compared with healthy references in the current study, VȮ 2peak was not associated with smoking status, and no difference in VȮ 2peak was found between smoking and non-smoking patients.…”
Section: Peak Oxygen Uptake Cardiovascular Risk and Schizophreniamentioning
confidence: 99%