title: Safety of long-term clozapine administration. Frequency of cardiomyopathy and hyponatraemia: two cross-sectional, naturalistic studies.
abstract: BACKGROUND
  The antipsychotic drug (APD) clozapine (CLZ) is under-prescribed because of concerns about its safety. We evaluated in separate protocols the frequency of cardiomyopathy and hyponatraemia, which are adverse drug effects, where few comparative studies are available.
  
  
  METHODS
  Cross-sectional studies in subjects treated for at least 3 consecutive months with the same drug were conducted. Cardiomyopathy: Patients undergoing treatment either with CLZ (n = 125) or with other typical or atypical APDs (n = 59) were examined by a cardiologist who also recorded echocardiograms and electrocardiograms in order to diagnose cardiomyopathy. Hyponatraemia: Fasting sodium levels were assessed in patients receiving any of the following treatments: CLZ (n = 88), other atypical APDs (n = 61), typical APDs (n = 23), typical + atypical APDs (n = 11), and other drugs/drug-free (n = 36).
  
  
  RESULTS
  Cardiomyopathy: No case of cardiomyopathy was detected. The frequency of abnormal ventricular ejection fraction (< 55%) was similar in both treatment groups (p = 1). Hyponatraemia: The frequency of hyponatraemia (percentage; 95% CI) was: CLZ (3.4%; -0.7, 7.1); other atypical APDs (4.9%; -0.5, 10.3); typical APDs (26.1%; 8.2, 44.0); typical + atypical APDs (9.1%; -7.8, 26.0); other drugs/drug-free (0%). None of the CLZ hyponatraemia subjects were on monotherapy.
  
  
  CONCLUSIONS
  Our results are at odds with previous studies of CLZ-associated cardiomyopathy. However, they must be compared to further cross-sectional or prospective studies because most published data come from either case reports or pharmacovigilance systems. The frequency of hyponatraemia during CLZ administration was similar to that observed with other atypical APDs, and it was significantly lower than that recorded with typical agents. These results, along with numerous case reports on the effects of CLZ in patients with polydipsia and water intoxication, point to a safe or even positive profile of CLZ on electrolytic regulation.
authors.affiliation: 1Department of Psychiatry, Los Andes University Medical School, Mérida, Venezuela.
authors.forename: Ana
authors.initials: A
authors.lastname: Serrano
authors.forename: Nairy
authors.initials: N
authors.lastname: Rangel
authors.forename: Edgardo
authors.initials: E
authors.lastname: Carrizo
authors.forename: Euderruh
authors.initials: E
authors.lastname: Uzcátegui
authors.forename: Ignacio
authors.initials: I
authors.lastname: Sandia
authors.forename: Angélica
authors.initials: A
authors.lastname: Zabala
authors.forename: Erika
authors.initials: E
authors.lastname: Fernández
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tálamo
authors.forename: Mercedes
authors.initials: M
authors.lastname: Servigna
authors.forename: Dexi
authors.initials: D
authors.lastname: Prieto
authors.forename: Lisette
authors.initials: L
authors.lastname: Connell
authors.forename: Trino
authors.initials: T
authors.lastname: Baptista
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000453:epidemiology*; D003024:Clozapine / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D014687:Venezuela / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Antipsychotics; cardiomyopathy; cardiotoxicity; clozapine; electrolytic regulation; hyponatraemia