Abstract
Background
Clozapine is a unique anti-psychotic medication that is most effective in the treatment
of refractory schizophrenia and reducing suicidality. Cardiomyopathy is among the
side effects of this medication that limits its use. There are a number of case reports,
case series and expert opinion papers discussing clozapine induced cardiomyopathy,
but there is no evidence-based review of the subject to guide clinicians.
Methods
We undertook a systematic review of the literature on cardiomyopathy associated with
clozapine. The primary systemic search was in MEDLINE but EMBASE, PsycINFO, and Cochrane
were searched and manufacturers of clozapine were contacted for cases. Articles were
then individually reviewed to find additional reports.
Results
We identified 17 articles detailing 26 individual cases and 11 additional articles
without individual case data. The mean age at time of diagnosis was 33.5 years. The mean dose of clozapine on presentation was 360 mg. Symptoms developed at an average of 14.4 months after initiating clozapine. The clinical presentation was generally consistent
with heart failure: including shortness of breath (60%) and palpitations (36%). Echocardiography
at presentation showed dilated cardiomyopathy in 39% of cases and was not specified
in other cases.
Conclusion
There should be a low threshold in performing echocardiography in suspected cases
of clozapine induced cardiomyopathy. Clozapine should be withheld in the setting of
cardiomyopathy without other explanation. There is limited data on the safety of drug
re-challenge in clozapine induced cardiomyopathy. Re-challenge may be considered in
carefully selected cases but close monitoring and frequent echocardiography are required.
Keywords
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Article info
Publication history
Published online: August 01, 2014
Accepted:
July 26,
2014
Received in revised form:
June 15,
2014
Received:
March 16,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
