Clozapine Use Presenting with Pseudopheochromocytoma in a Schizophrenic Patient: A Case Report

Sara, Jaskanwal D.; Jenkins, Matt; Chohan, Tanveer; Jolly, Karan; Shepherd, Lisa; Gandhi, Nirav; Shakher, Jayadave

doi:10.1155/2013/194927

Cited by 4 publications

(4 citation statements)

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“…The hypertension was accompanied by rise in urinary E and NE, to which all 3 anomalies subsided after interventions were introduced and CLZ was discontinued (Li et al, 1997 ). Paroxysmal hypertension was diagnosed, as with multiple other case reports of CLZ-associated hypertension and raised urinary catecholamines (Krentz et al, 2001 ; Akinsola and Ong, 2011 ; Sara et al, 2013 ). In addition to hypertension, Akinsola and Ong ( 2011 ) reported tachycardia of 140 bpm in a patient and Krentz et al ( 2001 ) reported 3 cases of accelerated HR ranging from 104 to 130 bpm.…”

Section: Resultsmentioning

confidence: 69%

“…In addition to hypertension, Akinsola and Ong ( 2011 ) reported tachycardia of 140 bpm in a patient and Krentz et al ( 2001 ) reported 3 cases of accelerated HR ranging from 104 to 130 bpm. The authors postulated CLZ-induced paroxysmal hypertension arose from the increase in NE spillover due to reduced reuptake into sympathetic nerve endings, α-adrenoceptor antagonism and/or increased vesicular fusion (Li et al, 1997 ; Krentz et al, 2001 ; Akinsola and Ong, 2011 ; Sara et al, 2013 ).…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, our results show CLZ is associated with fatal myocarditis, orthostatic hypotension, paradoxical hypertension and tachycardia. The results identified several characteristic features of CLZ's effects on the ANS: increased sympathetic activity, decreased vagal contribution, strong anticholinergic and antiadrenergic properties, increased E and NE and decreased HRV (Thomas and Marks, 1978 ; Nielsen et al, 1988 ; Zahn and Pickar, 1993 ; Ennis and Parker, 1997 ; Li et al, 1997 ; Agelink et al, 2001 ; Cohen et al, 2001a , b ; Tümüklü et al, 2008 ; Wang et al, 2008 , 2012 ; John et al, 2010 ; Mathewson et al, 2012 ; Huang et al, 2013 ; Sara et al, 2013 ; Leung et al, 2015 ). The studies, however, are short in duration with the longest clinical trial lasting 6 months (Huang et al, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

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Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

et al. 2018

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Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these.Objective: This systematic review summarizes the literature on autonomic dysfunction and related cardiovascular side effects associated with clozapine treatment.Method: A search of the EMBASE, MEDLINE, and EBM Cochrane databases was conducted using the search terms antipsychotic agents, antipsychotic drug*, antipsychotic*, schizophrenia, schizophren*, psychos*, psychotic*, mental ill*, mental disorder*, neuroleptic*, cardiovascular*, cardiovascular diseases, clozapine*, clozaril*, autonomic*, sympathetic*, catecholamine*, norepinephrine, noradrenaline, epinephrine, adrenaline.Results: The search yielded 37 studies that were reviewed, of which only 16 studies have used interventions to manage cardiovascular side effects. Side effects reported in the studies include myocarditis, orthostatic hypotension and tachycardia. These were attributed to sympathetic hyperactivity, decreased vagal contribution, blockade of cholinergic and adrenergic receptors, reduced heart rate variability and elevated catecholamines with clozapine use. Autonomic neuropathy was identified by monitoring blood pressure and heart rate changes in response to stimuli and by spectral analysis of heart rate variability. Metoprolol, lorazepam, atenolol, propranolol, amlodipine, vasopressin and norepinephrine infusion were used to treat tachycardia and fluctuations in blood pressure, yet results were limited to case reports.Conclusion: The results indicate there is a lack of clinical studies investigating autonomic dysfunction and a limited use of interventions to manage cardiovascular side effects associated with clozapine. As there is often no alternative treatment for refractory schizophrenia, the current review highlights the need for better designed studies, use of autonomic tests for prevention of cardiovascular disease and development of novel interventions for clozapine-induced side effects.

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Section: Resultsmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

et al. 2018

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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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Blood Pressure and Heart Rate Changes During Clozapine Treatment

et al. 2016

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People with schizophrenia are 3–4 times more likely to die from cardiovascular disease than the general population. Clozapine (CLZ) is the gold standard of treatment for refractory schizophrenia. It has been associated with tachycardia and recent evidence shows individuals prescribed CLZ may develop blood pressure (BP) elevation and hypertension. The purpose of this study was to examine the effects of CLZ on BP and heart rate (HR). This was a retrospective chart review of patients 18–75 years old with a DSM IV diagnosis of Schizophrenia or Schizoaffective disorder. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR measured 12 weeks before and 24 weeks during CLZ treatment. Eighteen patient records were included in this study. The mean stabilized CLZ dose was 441.7 ± 171.8 mg/day. DBP (t = 1.02, df = 79.5, = 2.00, 0.049) and HR (t = 1.32, df = 355 = −4.61, < 0.0001) were significantly higher after CLZ initiation. A trend was noted for increase in SBP (p = 0.071). 22 % of patients met criteria for hypertension before CLZ and 67 % during CLZ treatment (Chi Square = 6.25, df = 1, p = 0.0124). No significant changes in weight or renal function occured during CLZ treatment. No patients had evidence of cardiomyopathy. The data suggest CLZ may be associated with a rise in BP and HR. The results of this study support previous literature that found an increase in SBP/DBP regardless of CLZ dose, occurring early in treatment. Due to high risk of cardiovascular morbidity and mortality, more work is needed to determine risk factors and understand the mechanism of action that may cause this side effect.

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Clozapine Use Presenting with Pseudopheochromocytoma in a Schizophrenic Patient: A Case Report

Cited by 4 publications

References 9 publications

Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

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

Blood Pressure and Heart Rate Changes During Clozapine Treatment

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