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Clozapine–induced myocarditis after long–term treatment: case presentation and clinical perspectives

¹ Department of Psychiatry and Psychotherapy, Charité Medicine Berlin, Campus Mitte, Berlin, Germany
² Department of Cardiac Surgery, Heart Center Dresden, Germany
³ Department of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Heart Center Dresden, Germany.
⁵ Department of Cardiac Surgery, Heart Center Dresden, Germany.

^* To whom correspondence should be addressed.

	Abstract

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 (600mg) and amisulpride (800mg). 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

First published on February 28, 2008, doi:10.1177/0269881107082136

Journal of Psychopharmacology 2008;22:576.

A more recent version of this article appeared on July 1, 2008


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