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Clozapine-related tachycardia: A conundrum to identify and treat

Dermot Brennan1, Sweta Lal1,2, Frans Hugo1

  • 1Armadale Health Service, East Metropolitan Health Service, Armadale, WA, Australia.

Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists
|January 2, 2024
PubMed

Insights

Clozapine frequently causes tachycardia in patients with psychotic disorders. While beta-blockers can lower heart rates, they may not fully mitigate cardiovascular risks associated with clozapine treatment.

Area of Science:

  • Psychiatry
  • Cardiology
  • Pharmacology

Background:

  • Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia.
  • Clozapine is associated with significant cardiovascular side effects, including tachycardia.
  • The impact of beta-blockers on clozapine-induced tachycardia requires further investigation.

Purpose of the Study:

  • To determine the incidence and persistence of clozapine-induced tachycardia.
  • To assess the effect of beta-blockers on heart rate in patients treated with clozapine.
  • To analyze cardiovascular risks in a large cohort of patients with psychotic disorders.

Main Methods:

  • Retrospective audit of medical files for 101 patients receiving clozapine.
  • Analysis of monthly resting heart rate measurements.
  • Comparison of heart rates in patients treated with and without beta-blockers.

Main Results:

  • 51% of patients met criteria for clozapine-induced tachycardia.
  • Heart rates remained stable over the study period.
  • Beta-blockers demonstrated a small but statistically significant reduction in heart rates.

Conclusions:

  • Clozapine-induced tachycardia is common and its cardiovascular risks are often underestimated.
  • Beta-blockers may help manage elevated heart rates but might not fully eliminate cardiac risks.
  • Further research is needed to optimize cardiovascular safety in clozapine-treated patients.
Abstract

Keywords:
antipsychoticsatenololcardiovascular riskheart ratepropranololβ-blockers

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