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Journal of Psychopharmacology
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0269881107082136v1
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Clozapine-induced myocarditis after long-term treatment: case presentation and clinical perspectives

UE Lang

Department of Psychiatry and Psychotherapy, Charité Medicine Berlin, Campus Mitte, Berlin, Germany, undine.lang{at}gmx.de

M. Willbring

Department of Cardiac Surgery, Heart Center Dresden, Dresden, Germany

R. von Golitschek

Department of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland

A. Schmeisser

Department of Cardiology, Heart Center Dresden, Dresden, Germany

K. Matschke

Department of Cardiac Surgery, Heart Center Dresden, Dresden, Germany

S Malte Tugtekin

Department of Cardiac Surgery, Heart Center Dresden, Dresden, Germany

Clozapine is the drug of choice for treatment-resistant schizophrenia. Prompted by a patient who developed reversible clozapine-induced myocarditis after long-term treatment with clozapine for several years for chronic-resistant schizophrenia, we undertook a review of the relevant literature. Concerning the myocarditis, the patient recovered rapidly by withdrawal of clozapine and with supportive management. Psychiatric stabilisation of the patient was at least possible with a combination of quetiapine (600 mg) and amisulpride (800 mg).

Well-designed studies with the aim to specifically investigate treatment options after clozapine are limited and clinical possibilities are discussed in this paper. Olanzapine and combinations using non-clozapine atypical neuroleptics have partly shown improvement, whereas evidence for successful augmentation with mood stabilisers, anticonvulsants or electroconvulsive therapy in treatment-resistant schizophrenia is limited.

Key Words: myocarditis • clozapine • treatment-resistant • schizophrenia • cardiomyopathy • olanzapine • quetiapine • amisulpride

This version was published on July 1, 2008

Journal of Psychopharmacology, Vol. 22, No. 5, 576-580 (2008)
DOI: 10.1177/0269881107082136
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