Clozapine-induced cardiotoxicity: a clinical update.
Clozapine is a valuable drug for patients with treatment-resistant schizophrenia. Myocarditis is the most publicised cardiac complication of clozapine treatment, but cardiomyopathy and pericarditis have also been reported. Myocarditis has heterogeneous and non-specific presenting features, making it difficult to identify patients with clozapine-related myocarditis clinically. A high index of suspicion is required. The gold standard for diagnosis of myocarditis is an endomyocardial biopsy, but this is not a practical initial approach. Transthoracic echocardiography is a valuable, reproducible and widely available tool to assist in diagnosis of clozapine-induced cardiotoxicity. The level of B-type natriuretic peptide, a hormone secreted in response to ventricular wall stress, may be useful for evaluating patients with clozapine-induced cardiac dysfunction and may in the future be useful for screening asymptomatic patients. The mainstay of treatment of clozapine-induced cardiotoxicity is cessation of clozapine and provision of supportive care.
Layland
Jamie J
JJ
St Vincent's Hospital, Melbourne, VIC, Australia. jamie_layland@health.qld.gov.au
Liew
Danny
D
Prior
David L
DL
D014150:Antipsychotic Agents / Q000009:adverse effects*; D003024:Clozapine / Q000009:adverse effects*; D006801:Humans; D009205:Myocarditis / Q000139:chemically induced* / Q000175:diagnosis; D010493:Pericarditis / Q000139:chemically induced* / Q000175:diagnosis; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy
D014150:Antipsychotic Agents; D003024:Clozapine