Update on the adverse effects of clozapine: focus on myocarditis.
Clozapine, an atypical antipsychotic, is a dibenzodiazepine derivative and its therapeutic effects are probably mediated by dopaminergic and serotonergic activity. In accordance to several studies, it appears to be the most effective antipsychotic drug for treatment-resistant schizophrenia. Moreover, clozapine appears to be particularly beneficial in patients with schizophrenia who are suicidal and in those with comorbid substance use disorder. However, despite its efficacy, the general use of clozapine in clinical practice is somewhat limited because of the risk of several serious adverse effects such as agranulocytosis and thromboembolism. Clozapine may be associated with fatal myocarditis and cardiomyopathy in physically healthy young adults. Consequently, the FDA and the drug's manufacturer have strengthened warnings to include that a potentially fatal myocarditis may occur when taking clozapine. In the present paper the literature on clozapine-related myocardis will be reviewed and practical advice will be given concerning the diagnosis and management of such potentially fatal adverse effect.
National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, G. Mazzini Hospital, Teramo, Italy. dodebera@aliceposta.it
Domenico
D
De Berardis
Nicola
N
Serroni
Daniela
D
Campanella
Luigi
L
Olivieri
Francesca
F
Ferri
Alessandro
A
Carano
Marilde
M
Cavuto
Giovanni
G
Martinotti
Alessandra
A
Cicconetti
Monica
M
Piersanti
Francesco
F
Saverio Moschetta
Massimo
M
Di Giannantonio
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004348:Drug Labeling; D006801:Humans; D009205:Myocarditis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D012559:Schizophrenia / Q000188:drug therapy; D014481:United States; D014486:United States Food and Drug Administration
D014150:Antipsychotic Agents; D003024:Clozapine