Clozapine-induced cardiotoxicity: a clinical update

Med J Aust. 2009 Feb 16;190(4):190-2. doi: 10.5694/j.1326-5377.2009.tb02345.x.

Abstract

Clozapine is a valuable drug for patients with treatment-resistant schizophrenia. Myocarditis is the most publicised cardiac complication of clozapine treatment, but cardiomyopathy and pericarditis have also been reported. Myocarditis has heterogeneous and non-specific presenting features, making it difficult to identify patients with clozapine-related myocarditis clinically. A high index of suspicion is required. The gold standard for diagnosis of myocarditis is an endomyocardial biopsy, but this is not a practical initial approach. Transthoracic echocardiography is a valuable, reproducible and widely available tool to assist in diagnosis of clozapine-induced cardiotoxicity. The level of B-type natriuretic peptide, a hormone secreted in response to ventricular wall stress, may be useful for evaluating patients with clozapine-induced cardiac dysfunction and may in the future be useful for screening asymptomatic patients. The mainstay of treatment of clozapine-induced cardiotoxicity is cessation of clozapine and provision of supportive care.

MeSH terms

  • Antipsychotic Agents / adverse effects*
  • Clozapine / adverse effects*
  • Humans
  • Myocarditis / chemically induced*
  • Myocarditis / diagnosis
  • Pericarditis / chemically induced*
  • Pericarditis / diagnosis
  • Risk Factors
  • Schizophrenia / drug therapy

Substances

  • Antipsychotic Agents
  • Clozapine