Beta-blocker and angiotensin-converting enzyme inhibitor may limit certain cardiac adverse effects of clozapine.
Clozapine is contraindicated in patients who experienced cardiac adverse effects during therapy. A young male (34 years old) with clozapine-responsive schizophrenia developed hypokinetic cardiomyopathy during treatment. The decision to resume clozapine therapy and to treat cardiac problems with carvedilol and captopril was made due to the failure of other antipsychotics to control symptoms. He was followed up for 5 years. Significant improvement of psychiatric conditions and persistence of normal left ventricular function were obtained with combination treatment. beta-Blockers and ACE inhibitors may allow resumption of clozapine in refractory schizophrenia in whom it was withdrawn for cardiotoxicity. A large-scale investigation may be useful to confirm the present observations.
Rostagno
Carlo
C
Cardiologia Generale, AOU Careggi, Florence, Italy. c.rostagno@katamail.com
Di Norscia
Gianni
G
Placidi
Gian Framco
GF
Gensini
Gian Franco
GF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000187:drug effects; D004562:Electrocardiography / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D011412:Propanolamines / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000188:drug therapy*; D013616:Tachycardia, Sinus / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014150:Antipsychotic Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D002216:Captopril; D003024:Clozapine