Clozapine-Associated Myocarditis: Case Report and Literature Review

Barry, Arden R.; Windram, Jonathan; Graham, Michelle M.

doi:10.4212/cjhp.v68i5.1493

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…As was true for our case, the cases of clozapine-induced hypertension have been reported among males only, aged 32–49 years,[ 3 4 5 6 7 ] who had no history of hypertension in the past. [ 3 4 6 7 ] However, the onset of hypertension during clozapine initiation was associated with other abnormalities such as myocarditis,[ 11 12 13 ] pseudopheochromocytoma,[ 14 15 16 17 ] and hypokalemia. [ 7 ] Hence, whenever a patient develops hypertension with use of clozapine, it is important to thoroughly evaluate for other possible causes, which could contribute or lead to hypertension.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-induced hypertension: A case report and review of literature

Grover

Mahajan

2017

Ind Psychiatry J

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There are very few reports which suggest an association between clozapine and hypertension. We report a case in which a direct link of initiation of clozapine to development of hypertension which required pharmacological intervention. A 32-year-old male who did not have any history of hypertension and had normal blood pressure at the baseline developed high blood pressure (i.e., 150/90 mmHg) while on clozapine 100 mg/day. Reduction of the dose of clozapine to 75 mg/day led to the return of blood pressure to baseline, with increase in blood pressure to 150/90 mmHg on increasing the dose of clozapine again, requiring tablet atenolol 50 mg/day for normalization of blood pressure with concomitant continuation of atenolol. Later, clozapine was increased to 350 mg/day, with no recurrence of raise in blood pressure. After 6 months, tablet atenolol was stopped with no evidence of hypertension in follow-up. To conclude, this case report suggests that clozapine can rarely lead to hypertension during the initial phase of treatment.

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Section: Discussionmentioning

confidence: 99%

Clozapine-induced hypertension: A case report and review of literature

Grover

Mahajan

2017

Ind Psychiatry J

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“…Myocarditis rate due to clozapine use has been reported to be about 1%. If myocarditis is not identified and treated, it may result to death [10][11][12][13] . Myocarditis is rarely recognized clinically.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Myocarditis in Long Term Use of Antipsychotics: Case Series and Review of the Literature

Şahpaz

Pehlivan

Türkkan

et al. 2016

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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Eosinophilic myocarditis in long term use of antipsychotics: case series and review of the literature Long term use of antipsychotics, is encountered in many psychiatric disorders, especially in schizophrenia. Eosinophilic myocarditis is a rare form of myocarditis characterized by myocardial inflamation composed of mostly eosinophils. It is known that it may develop at a rate of 0.2-3 % in long term therapies, especially with clozapine use. Standart treatment can not be established because of rarity of disease and difficulties in the determination of the etiology. In this article, three cases, who have been receiving long term drug treatment for schizoaffective disorder and faced sudden death, were presented. Their autopsies were performed in our institution. When myocardial sections were examinated with light microscope, common findings with three cases were, myocyte damage accompanied with patchy distribution of perivascular and interstitial inflamatory infiltrate rich in eosinophils. When the light microscopic findings evaluated with detailed medical history, autopsy findings and toxicological analysis results, we considered these entities may have developed as a result of hypersensitivity reaction due to long term antipsychotic drug use. Eosinophilic myocarditis is encountered as a rare clinical entity and probably it is a subtype of myocarditis that is overlooked. Failure in the clinical diagnosis and delay in treatment may lead to irreversible myocardial damage and death. Endomyocardial biopsy is still the gold standard in the diagnosis of eosinophilic myocarditis. Here, we present these cases since the drug use is the most frequently accused cause, it is rarely seen in acute deaths and the diagnosis can be reached by histopathological examination.

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“…Возникновение жизнеугрожающих побочных эффектов отмечено также и при приеме терапевтических доз препарата. Среди них значимое место занимают неблагоприятные кардиальные эффекты, такие как миокардиты, кардиомиопатии, перикардиты, сердечная недостаточность, внезапная сердечная смерть [7][8][9][10][11]. A. Al-Wahab и соавт.…”

Section: Introductionunclassified

“…Occurrence of life-threatening side effects was also noted during intake of therapeutic doses of the drug. An important role among them belongs to adverse cardiac effects such as myocarditis, cardiomyopathy, pericarditis, heart failure, sudden cardiac death [7][8][9][10][11]. A. Al-Wahab et al revealed in an experimental study the increased levels of noradrenaline, adrenaline, troponins, creatine phosphokinase-MB, interleukins, tumor necrosis factor alpha, cytokines in the blood of mice that received Clozapine [12,13].…”

Section: Introductionmentioning

confidence: 99%

Morphological and Functional Alterations of the Cardiovascular System during Acute Clozapine Poisoning (Experimental Study)

Babkina

Рыжков

Antonova

et al. 2019

Obŝaâ reanimatologiâ

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Purpose of the study. To evaluate the influence of sublethal dose of Clozapine on the functional and morphological parameters of the cardiovascular system in rats 4 hrs. after the drug administration.Materials and methods. The experiments were carried out on male Wistar rats weighing 200–250g (n=14). Group I received 0.9% NaCl solution administered via enteral feeding tubing under general anesthesia using Sevoflurane; group II — Clozapine dosed at 150 mg/kg in 0.9% NaCl solution; group III — Clozapine dosed at 150 mg/kg in 40% ethyl alcohol solution. 4 hrs. after drug administration, arterial blood pressure (ABP), heart rate (HR), microcirculation in the skin using laser Doppler flowmetry (LSF), fluorescence intensity of coenzymes NADH and FAD were evaluated. After euthanasia, autopsy including withdrawal of the internal organs of rats for morphological analysis was performed. Thereafter, paraffin sections of hearts were made and subsequently stained with hematoxylin and eosin, which were later examined with the help of light microscope Nikon Eclipse Ni-U.Results. In both Clozapine groups, ABP and blood flow in the skin were lower than in the control group: ABP — by 12% in group I and by 15% in group II; blood flow — by 48% and 37%, respectively. No significant difference between the groups was observed in respect of the microcirculation indices studied. Increased fluorescence intensity of coenzyme NADH in the skin was found in the Clozapine groups compared to the control group (2.3-fold in group I and 1.9-fold in group II). Histological analysis of the hearts of animals that received Clozapine established uneven blood filling, erythrocyte sludges, fine-focal hemorrhaging, endotheliocyte nuclei oriented perpendicular to the basal membrane, uneven staining of myocardium with hypereosinophilic segments, fragmentation and undulating deformity of muscle fibers.Conclusion. During acute Clozapine poisoning, morphological signs of disturbed circulation and myocardium damage are found in the heart, which are accompanied with development of myocardium dysfunction with arterial hypotension and decreased peripheral blood flow, also disturbed oxidative metabolism in peripheral tissues.

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Clozapine-Associated Myocarditis: Case Report and Literature Review

Cited by 8 publications

References 9 publications

Clozapine-induced hypertension: A case report and review of literature

Clozapine-induced hypertension: A case report and review of literature

Eosinophilic Myocarditis in Long Term Use of Antipsychotics: Case Series and Review of the Literature

Morphological and Functional Alterations of the Cardiovascular System during Acute Clozapine Poisoning (Experimental Study)

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