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Clozapine associated cardiotoxicity: Issues, challenges and way forward
Guna Kanniah1, Shailesh Kumar1
1Waikato Clinical Campus, University of Auckland, New Zealand.
Asian Journal of Psychiatry
|February 29, 2020
Summary
Clozapine can cause heart problems like myocarditis and cardiomyopathy, which may be underreported. Early detection through monitoring is key to managing clozapine associated cardiotoxicity (CACT) and enabling safe re-challenge.
Area of Science:
- Pharmacology
- Cardiology
- Psychiatry
Background:
- Clozapine is an effective antipsychotic but carries risks of cardiotoxicity.
- Clozapine-associated cardiotoxicity (CACT) encompasses myocarditis and cardiomyopathy, with varying incidence and severity.
- Subclinical cardiotoxicity is more common than overt myocarditis or cardiomyopathy.
Purpose of the Study:
- To review literature on clozapine associated cardiotoxicity (CACT).
- To summarize diagnostic features of CACT.
- To evaluate monitoring and re-challenge procedures for safe clozapine use.
Main Methods:
- Literature review of published studies on clozapine associated cardiotoxicity.
- Analysis of diagnostic criteria and clinical presentations.
- Evaluation of monitoring protocols and re-challenge strategies.
Main Results:
- Clozapine-associated Myocarditis (CAM) is infrequent but serious, with diagnosis complicated by non-specific symptoms.
- Clozapine-associated Cardiomyopathy (CAC) has higher mortality rates (12.5-24.0%) and re-challenge is generally not advised.
- Subclinical CACT is prevalent, challenging diagnosis but amenable to active monitoring and cautious re-challenge protocols.
Conclusions:
- CACT, including myocarditis and cardiomyopathy, may be underreported globally.
- Early identification of subclinical cardiotoxicity improves patient outcomes.
- A pragmatic monitoring protocol with cardiac biomarkers is proposed for early CACT detection.
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