Update on the adverse effects of clozapine: focus on myocarditis

Curr Drug Saf. 2012 Feb;7(1):55-62. doi: 10.2174/157488612800492681.


Clozapine, an atypical antipsychotic, is a dibenzodiazepine derivative and its therapeutic effects are probably mediated by dopaminergic and serotonergic activity. In accordance to several studies, it appears to be the most effective antipsychotic drug for treatment-resistant schizophrenia. Moreover, clozapine appears to be particularly beneficial in patients with schizophrenia who are suicidal and in those with comorbid substance use disorder. However, despite its efficacy, the general use of clozapine in clinical practice is somewhat limited because of the risk of several serious adverse effects such as agranulocytosis and thromboembolism. Clozapine may be associated with fatal myocarditis and cardiomyopathy in physically healthy young adults. Consequently, the FDA and the drug's manufacturer have strengthened warnings to include that a potentially fatal myocarditis may occur when taking clozapine. In the present paper the literature on clozapine-related myocardis will be reviewed and practical advice will be given concerning the diagnosis and management of such potentially fatal adverse effect.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / therapy
  • Clozapine / adverse effects*
  • Clozapine / therapeutic use
  • Drug Labeling
  • Humans
  • Myocarditis / chemically induced*
  • Myocarditis / diagnosis
  • Myocarditis / therapy
  • Schizophrenia / drug therapy
  • United States
  • United States Food and Drug Administration


  • Antipsychotic Agents
  • Clozapine