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Title: Case Study Highlights Risk of Dilated Cardiomyopathy with Clozapine Use

URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R
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Postgrad Med J 2003 July;79:933:412-413. "Clozapine associated dilated cardiomyopathy"
09/10/2003 11:22:35 AM
By Emma Hitt, PhD

ERRATUM: Case Study Highlights Risk of Dilated Cardiomyopathy with Clozapine Use There was an error in a review (Aug. 6, 2003) of a paper in Postgraduate Medical Journal. The original text read: An electrocardiogram indicated the presence of sinus tachycardia, voltage criteria for left ventricular hypertrophy, and a prolonged QTc interval, and electrocardiographic findings were consistent with a dilated cardiomyopathy. The corrected text now reads: An electrocardiogram indicated the presence of sinus tachycardia, voltage criteria for left ventricular hypertrophy, and a prolonged QTc interval, and echocardiographic findings were consistent with a dilated cardiomyopathy. We apologise to the manufacturer for having published inaccurate information on their product. We are committed to providing the most accurate, relevant and balanced information for physicians worldwide and have devoted considerable resources to ensuring this. We deeply regret this error. ------------------------------------------------------ A case study of clozapine-induced dilated cardiomyopathy highlights the need for patients to be informed of potential cardiac symptoms while taking clozapine and for doctors to be vigilant during treatment. Clozapine is a dibenzodiazepine antipsychotic used to treat resistant schizophrenia. Minor cardiovascular side effects, such as orthostatic hypotension and sinus tachycardia, are relatively common. In addition, myocarditis and dilated cardiomyopathy, which are potentially lethal, have also been reported with clozapine. Incidence of myocarditis has been estimated at between 1 in 10,000 to 1 in 500. "Between 1989 and 1999 the United States Food and Drug Administration received reports of 28 cases of myocarditis (including 18 deaths) and 41 cases of cardiomyopathy (including 10 deaths) in patients receiving clozapine," note Mark Tanner, MD, and William Culling, Cardiology Department, Kingston Hospital, Kingston-upon-Thames, Surrey, United Kingdom. In their report, Dr. Tanner and colleagues describe the case of a 31-year-old white man with persistent sinus tachycardia. He had a history of chronic schizophrenia, which had been treated with clozapine for 6 years. An electrocardiogram indicated the presence of sinus tachycardia, voltage criteria for left ventricular hypertrophy, and a prolonged QTc interval, and echocardiographic findings were consistent with a dilated cardiomyopathy. "The greatest risk of cardiac involvement most commonly occurs during the first month of use, although as reported in this case, risk persists throughout its use," the researchers note. "It is also likely that myocarditis typically presents earlier than cardiomyopathy," they add. The patient appeared to improve when clozapine was withdrawn. Corticosteroids in addition to standard supportive treatment for myocarditis and cardiomyopathy may also benefit these patients, the authors suggest. "Patients should be informed of symptoms of cardiotoxicity. It is important that a high degree of clinical suspicion is maintained throughout the duration of clozapine therapy with a low threshold for referral to a cardiologist," they conclude.

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