Ivabradine, a novel treatment for clozapine-induced sinus tachycardia: a case series

Abstract

This is the first report in the literature demonstrating that ivabradine appears to be a well tolerated agent, which should be considered as a symptomatic treatment of clozapine-induced tachycardia if the use of a β blocker fails due to a lack of response or intolerability.

Rapid-onset supraventricular tachycardia following clozapine initiation and its management with verapamil: a case report

“…Other potential causes, such as myocarditis, cardiomyopathy, or neuroleptic malignant syndrome were ruled out since the absence of the symptoms with normal cardiac markers and rapid resolve of tachycardia following clozapine cessation. 8,9 In contrast to this case, most of the previously-reported ones presented with tachycardia at clozapine doses over 50 mg. [10][11][12][13][14][15] The only exception, 37.5 mg/day, still greatly exceeded the dose described here. 16 Furthermore, the onset of tachycardia in those cases ranged from five days to two months after clozapine initiation, much longer than two days observed in this case.…”

“…Only a few presented with SVT and these were mainly dose-dependent and involved rapid titration. [10][11][12][13][14][15][16] However, in this case, SVT developed early (two days) after a low dose of clozapine (25 mg) was slowly titrated.…”

“…11,13 Additionally, in a case series with two patients, clozapine-induced tachycardia was effectively resolved using ivabradine, this novel compound is intended to regulate heart rate and represents an alternative option for patients who are intolerant to β blockers. 12 Overall, this area remains largely clinically unexplored and large-scale studies on the management of clozapine-induced tachycardia are needed. The effective management of adverse side effects, such as clozapine-induced tachycardia, will greatly improve the outcome and quality of life for patients with schizophrenia and reduce the premature clozapine discontinuation.…”

1011. Tachycardia in Patients Treated with Clozapine versus Antipsychotic Long-Acting Injections

“…According to our own experience, β-blockers for example, low doses of bisoprolol, are well tolerated and β-block addon may also offer symptomatic relief in patients who are aware of and suffer from tachycardia. However, clozapine often causes orthostatic reactions and in the case of hypotension or orthostatism, ivabradine may be a better option (Lally et al, 2014). A liberal use of Therapeutic Drug Monitoring with controls of serum clozapine levels is strongly recommended as our data suggest a dose-response relationship for tachycardia.…”

The practical management of refractory schizophrenia - the Maudsley Treatment REview and Assessment Team service approach

“…If confirmed as a benign sinus tachycardia, then slowing the rate of titration may help. Beta‐blockers or ivabradine may be necessary if persistent .…”