Successful Re-exposure to Clozapine after Eosinophilia and Clinically Suspected Myocarditis

Granja-Ingram, Nara Matos; James, Jason; Clark, Nathaniel; Stovall, Jeffrey; Heckers, Stephan

doi:10.1016/j.rbp.2012.10.005

Cited by 11 publications

(7 citation statements)

References 3 publications

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“…[3][4][5][6][7][8][9][10] According to the manufacturer's Canadian monograph, the estimated incidence of myocarditis is 1 per 14 000 patientyears, with a mortality rate of 23%. 1 Other studies have estimated the incidence at between 0.015% and 0.188% (up to about 1 in 500), with one case series estimating the incidence to be as high as 0.7%-1.2% (up to about 1 in 100).…”

Section: Discussionmentioning

confidence: 99%

“…A small number of case reports in the published literature have described successful rechallenge with clozapine in patients with suspected clozapine-associated myocarditis. 9,10 If rechallenge is undertaken, clozapine should be started at a low dose and should progress with slow dose titration and frequent monitoring of both troponin and cardiac function.…”

Section: Discussionmentioning

confidence: 99%

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Clozapine-Associated Myocarditis: Case Report and Literature Review

Barry

Windram²,

Graham

2015

CJHP

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clozapine-Associated Myocarditis: Case Report and Literature Review

Barry

Windram²,

Graham

2015

CJHP

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“…The re-introduction of clozapine is always carried out in a hospital setting, after all signs of myocarditis have disappeared, both in the clinical examination and in additional tests. In such cases, the dose is increased slowly, patients are closely monitored for any signs of relapse, and close cooperation is necessary between psychiatrists and cardiologists [25,69,87,[103][104][105][106]. Cook et al point out that there are relative contraindications to reintroducing clozapine after CIM, such as the existence of pre-clozapine treatment symptoms that might imitate CIM symptoms, e.g.…”

Section: Discontinuation Of Clozapine Treatment What Next?mentioning

confidence: 99%

“…Próby ponownego wdrożenia klozapiny po przebytym CIM prowadzone są w warunkach szpitalnych, po całkowitym ustąpieniu oznak zapalenia mięśnia sercowego zarówno w badaniu klinicznym, jak i w przeprowadzonych badaniach dodatkowych. W takich przypadkach obowiązuje powolne zwiększanie dawki leku, częsta ocena laboratoryjnych i klinicznych oznak nawrotu choroby oraz ścisła współpraca na linii psychiatra-kardiolog [25,69,87,[103][104][105][106]. Jak wskazują Cook i wsp., względnym przeciwwskazaniem do podejmowania prób ponownego leczenia klozapiną po przebytym CIM jest występowanie wyjściowej patologii, której objawy mogą naśladować dolegliwości (np.…”

Section: Odstawienie Klozapiny I Co Potemunclassified

Clozapine-induced myocarditis

Jahołkowski¹,

Mierzejewski²,

Świtaj³

2019

ppn

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Purpose: Presentation of the current state of knowledge on the epidemiology, pathogenesis, clinical picture, diagnosis and treatment of clozapine-induced myocarditis (CIM). Views: Clozapine is widely used in patients with psychotic disorders for whom previous therapy was inadequate or not tolerated. However, in some cases its use may be associated with serious side-effects. In addition to agranulocytosis, ketoacidosis and intestinal obstruction, CIM is the most serious and potentially life-threatening complication of clozapine therapy, as it encompasses the inflammation and injury of the heart muscle. Attempts to estimate the incidence of CIM are characterized by a large discrepancy of results. To date, the pathomechanism of CIM has not been well investigated. The variability of the clinical spectrum and the lack of pathognomonic signs significantly hinder diagnosis, which is usually based on clinical symptoms, echocardiography, concentration of troponin and C-reactive protein in the serum samples and, in some cases, by myocardial biopsy and cardiac magnetic resonance imaging. In patients with suspected/confirmed CIM, the main recommendation is to discontinue clozapine and monitor the patient's vital signs. Clinical observations indicate that a β-blocker and/or angiotensin-converting enzyme inhibitor might be useful in at least same cases of CIM. Conclusions: We point out that patients receiving clozapine should be carefully monitored for the symptoms of CIM. The publication contains guidelines for dealing with suspected CIM.

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“…This case adds to the 17 cases of clozapine re-challenge following myocarditis, of which 71% were successful (12 cases). 3,[6][7][8][9][10][11][12][13][14][15] This demonstrates that re-challenge could be performed safely and effectively in the context of clozapine-induced myocarditis, if accompanied by a strict and rigorous monitoring protocol. Importantly, there were no deaths in the five unsuccessful cases published where myocarditis recurred.…”

mentioning

confidence: 99%