Pharmacological interventions for clozapine-induced sinus tachycardia

Lally, John; Docherty, Mary; MacCabe, James H.

doi:10.1002/14651858.cd011566

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…We propose that these patients should be investigated by ECG and persistent tachycardia should be treated. A recent Cochrane review on pharmacological intervention for clozapine-induced sinus tachycardia showed a lack of controlled studies and was thus unable to confidently inform clinical practice ( Lally et al , 2016 ). Nevertheless, the addition of β-blockers has long been an effective clinical alternative for the treatment of clozapine-associated tachycardia ( Stryjer et al , 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Tachycardia in patients treated with clozapine versus antipsychotic long-acting injections

Nilsson

Edström

Lindström

et al. 2017

International Clinical Psychopharmacology

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Tachycardia is a known adverse effect during clozapine treatment. However, prevalence reported differs widely between studies and hitherto there are no studies comparing clozapine-treated patients with a similar control group. The present study was carried out to assess the prevalence of tachycardia in patients treated with clozapine and antipsychotic long-acting injections (LAI). Data on heart rate (HR), concomitant medication, and relevant anthropometric and laboratory measurements were collected for all clozapine-treated patients (n=174) in a defined catchment area and compared with data on patients treated with LAI (n=87). In total, 33% of patients on long-term clozapine treatment had tachycardia (HR>100) compared with 16% in the LAI group (P<0.001). The mean HR was 91 in the clozapine group and 82 in the LAI group (P<0.001). Clozapine dose correlated with HR. The majority of patients with HR more than 100 received no specific treatment for tachycardia. In conclusion, the prevalence of tachycardia was twice as high in patients treated with clozapine as in a similar patient group with severe schizophrenia spectrum disorder. The tachycardia was in many cases clinically unnoticed. Tachycardia during antipsychotic treatment is a common phenomenon that must be monitored for actively and, when noticed, further investigated and treated.

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Section: Discussionmentioning

confidence: 99%

Tachycardia in patients treated with clozapine versus antipsychotic long-acting injections

Nilsson

Edström

Lindström

et al. 2017

International Clinical Psychopharmacology

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“…This finding is consistent with the known high prevalence of tachycardia in patients prescribed clozapine. 23 Only elevated troponin had high specificity (89.1%). Both elevated troponin and CRP were found to be good diagnostic measures for myocarditis with a ROC AUC of 0.975 and 0.896, respectively.…”

Section: Main Findingsmentioning

confidence: 96%

Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy

et al. 2021

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Background Clozapine is associated with increased risk of myocarditis. However, many common side-effects of clozapine overlap with the clinical manifestations of myocarditis. As a result, there is uncertainty about which signs, symptoms and investigations are important in distinguishing myocarditis from benign adverse effects of clozapine. Clarity on this issue is important, since missing a diagnosis of myocarditis or discontinuing clozapine unnecessarily may both have devastating consequences. Aims To examine the clinical characteristics of clozapine-induced myocarditis and to identify which signs and symptoms distinguish true myocarditis from other clozapine adverse effects. Method A retrospective analysis of the record database for 247 621 patients was performed. A natural language processing algorithm identified the instances of patients in which myocarditis was suspected. The anonymised case notes for the patients of each suspected instance were then manually examined, and those whose instances were ambiguous were referred for an independent assessment by up to three cardiologists. Patients with suspected instances were classified as having confirmed myocarditis, myocarditis ruled out or undetermined. Results Of 254 instances in 228 patients with suspected myocarditis, 11.4% (n = 29 instances) were confirmed as probable myocarditis. Troponin and C-reactive protein (CRP) had excellent diagnostic value (area under the curve 0.975 and 0.896, respectively), whereas tachycardia was of little diagnostic value. All confirmed instances occurred within 42 days of clozapine initiation. Conclusions Suspicion of myocarditis can lead to unnecessary discontinuation of clozapine. The ‘critical period’ for myocarditis emergence is the first 6 weeks, and clinical signs including tachycardia are of low specificity. Elevated CRP and troponin are the best markers for the need for further evaluation.

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