A comparative study of detection of myocarditis induced by clozapine: With and without cardiac monitoring. (September 2019)

• Record Type: Journal Article
• Authors: Yağcıoğlu, Anıl; Ertuğrul, Aygün; Karakaşlı, Ahmet Alp; Ağaoğlu, Esen; Ak, Sertaç; Karahan, Sevilay; Yazıcı, M. Kâzım
• Is Part Of: Psychiatry research. Volume 279(2019)
• Page Start: 90
• Page End: 97
• Publication Date: 2019-09
• Subjects: Clozapine -- Myocarditis -- Adverse effects -- Life threatening -- Risk factors; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2019.07.008
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Cardiac monitoring leads to an increase in the detection of clozapine induced myocarditis. (CIM). If not monitored, the outcome of CIM can be fatal without any warning signs and symptoms. Close monitoring may be preferred in cases with milder clinical presentation of CIM. Concominant use of mood stabilizers is an important risk factor for the development of CIM. Abstract: The aim of this study was to investigate and compare the incidence of suspected or definite cases of clozapine induced myocarditis (SDM) and clinical factors which could influence its onset in two different time periods, defined by pre- and post-cardiac monitoring at an inpatient setting, during the initiation phase of clozapine treatment. Hospital records of patients started on clozapine in the inpatient unit between 2011 and 2018 were investigated. Eight in 38 patients (11.3%) were classified as SDM after the initiation of the monitoring protocol, whereas only 1 in 33 patients (1.4%) was classified as SDM, before. Monitored and non-monitored patient groups were similar with regard to demographic and clinical variables. Diagnosis of schizoaffective disorder and use of concominant lithium, valproic acid and atypical antipsychotics were higher in patients with SDM, while clozapine dose titration was similar compared to the rest of the patients. Cardiac monitoring seems to be the main factor leading to the increase in the detection of clozapine induced myocarditis (CIM). If not monitored, the outcome of CIM can be fatal without any warning signs and symptoms. Concominant use of mood stabilizers including valproic acid and lithium, are important risk factors for the development of CIM.