title: Clozapine-induced myocarditis after long-term treatment: case presentation and clinical perspectives.
abstract: Clozapine is the drug of choice for treatment-resistant schizophrenia. Prompted by a patient who developed reversible clozapine-induced myocarditis after long-term treatment with clozapine for several years for chronic-resistant schizophrenia, we undertook a review of the relevant literature. Concerning the myocarditis, the patient recovered rapidly by withdrawal of clozapine and with supportive management. Psychiatric stabilisation of the patient was at least possible with a combination of quetiapine (600 mg) and amisulpride (800 mg). Well-designed studies with the aim to specifically investigate treatment options after clozapine are limited and clinical possibilities are discussed in this paper. Olanzapine and combinations using non-clozapine atypical neuroleptics have partly shown improvement, whereas evidence for successful augmentation with mood stabilisers, anticonvulsants or electroconvulsive therapy in treatment-resistant schizophrenia is limited.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité Medicine Berlin, Campus Mitte, Berlin, Germany. undine.lang@gmx.de
authors.forename: U E
authors.initials: UE
authors.lastname: Lang
authors.forename: M
authors.initials: M
authors.lastname: Willbring
authors.forename: R
authors.initials: R
authors.lastname: von Golitschek
authors.forename: A
authors.initials: A
authors.lastname: Schmeisser
authors.forename: K
authors.initials: K
authors.lastname: Matschke
authors.forename: S
authors.initials: S
authors.lastname: Malte Tugtekin
mesh_terms: D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced*; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy; D013469:Sulpiride / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D013469:Sulpiride; D000077582:Amisulpride; D003024:Clozapine