Clozapine Rechallenge Following Clozapine-Induced Pericarditis

Crews, Matthieu; Dhillon, Gurbinder S.; MacCabe, James H.

doi:10.4088/jcp.09l05692yel

“…al., 2005). In the patients in whom clozapine rechallenge was attempted, the psychotic symptoms returned despite treatment with other antipsychotics once the clozapine treatment was discontinued (Mathewson and Lindenmayer, 2007; Crews et. al 2010; DasGupta and Young, 1991; Bray, 2008; Silvestrini, et.…”

Section: Discussionmentioning

confidence: 99%

“…The clozapine acceptance by patients and the frequency of its prescribing by clinicians have been hampered by apprehension regarding adverse effects with life-threatening potential, notably significant agranulocytosis and neutropenia (Alvir et al,1993; Gersen, 1994), myocarditis (Merrill et al, 2005; Pieroni et al, 2004; Reinders et al, 2004), cardiomyopathy (Reinders et al, 2004), pericarditis (Crews et al, 2010; Rathore et al, 2007), alveolitis (Arias et al, 2011), pancreatitis (Bayard et al, 2005), hepatitis (Chang et al, 2009), nephritis (Au et al, 2004), colitis (Pelizza and Melegari, 2007), drug-induced lupus erythomatosus (Rami et al, 2006), status epilepticus (Gandelman-Marton et al, 2008), diabetic ketoacidosis and hyperosmolar coma (Cohen and Correll 2009), and neuroleptic malignant syndrome (Miller et al, 1991). …”

mentioning

confidence: 99%

When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature

Manu¹,

Sarpal²,

Muir³

et al. 2012

Schizophrenia Research

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Background Clozapine is widely prescribed for treatment refractory patients with schizophrenia, but its use is limited by potentially life threatening adverse effects. Rechallenge after these complications has been occasionally attempted in patients with severe psychotic symptoms. Objective To review the outcome of clozapine rechallenge after potentially life threatening adverse effects. Methods Electronic, all-language, literature search (1972–2011) followed by demographic and clinical data extraction. The outcome of rechallenge was considered favorable when the lower bound of the 95% confidence interval (CI) of the proportion of patients who could continue clozapine was >50%. Results Altogether, 138 patients (mean age: 36.3 years, 65.7% male, 57.6% Caucasian, virtually all with schizophrenia spectrum diagnosis) underwent clozapine rechallenge after developing neutropenia (n=112), agranulocytosis (n=15), neuroleptic malignant syndrome (NMS) (n=5), myocarditis (n=4), pericarditis (n=1) and lupus erythematosus (n=1). Rechallenge strategies were heterogeneous and not systematically evaluated. Clozapine rechallenge was successful in 78/112 patients (69.6%, CI:60.6–77.4) after neutropenia, 3/15 (20%, CI:7.1–45.2) after agranulocytosis, 5/5 (100%, CI:56–100) after NMS, 3/4 (75%, CI:30–95) after myocarditis, 1/1 after pericarditis, and 0/1 after clozapine-induced lupus. Successfully rechallenged patients were followed for 16–96 weeks. None of the rechallenged patients died. Conclusions Although controlled studies are clearly needed, using a priori, confidence interval-based criteria, case reports/series suggest that in refractory patients who benefited from clozapine, careful rechallenge can be considered after neutropenia and NMS, but not after agranulocytosis and myocarditis.

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“…4,10) In some cases a clozapine rechallenge was tried, but this strategy is controversial as pericarditis may develop again, even it is not the rule. 11,12) There is only one report that has investigated the long-acting aripiprazole/clozapine combination in a case of ultra-resistant schizophrenia without insurgence of adverse effects. 13) However, in our case, we cannot exclude that this combination may have contributed to cause the observed clozapine-related pericarditis.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

Berardis

¹

,

Fornaro

²

,

Orsolini

³

et al. 2018

Clin Psychopharmacol Neurosci

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Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine.

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“… 4 , 10) In some cases a clozapine rechallenge was tried, but this strategy is controversial as pericarditis may develop again, even it is not the rule. 11 , 12) …”

Section: Discussionmentioning

confidence: 99%

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

Berardis

¹

,

Fornaro

²

,

Orsolini

³

et al. 2018

Clin Psychopharmacol Neurosci

View full text Add to dashboard Cite

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine.

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Clozapine Rechallenge Following Clozapine-Induced Pericarditis

Cited by 20 publications

References 9 publications

When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature

When can patients with potentially life-threatening adverse effects be rechallenged with clozapine? A systematic review of the published literature

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

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