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Clozapine associated with myocarditis and cardiomyopathy
- Detlef Degner, Borwin Bandelow, Renate Grohmann, and Eckart Rüther (18 November 2003)
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Detlef Degner, MD Department of Psychiatry,University of Göttingen,Germany, Borwin Bandelow, Renate Grohmann, and Eckart Rüther
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ddegner{at}gwdg.de Detlef Degner, et al.
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Dear Editor In their article, Tanner and Culling describe the risk of cardiomyopathy in clozapine treatment.[1] Kilian et al.[2] reported about 15 patients with myocarditis and cardiomyopathy out of 8000 patients treated with clozapine (0.178%) in Australia. In the European Drug Safety Program (AMSP) in Germany,Austria , and Switzerland,3 cases of myocarditis among 10,263 monitored patients with clozapine therapy were observed (0.029%). In all these cases young male patients with schizophrenia in good cardiovascular condition were affected. Symptoms started 13 to 20 days after clozapine initiation (e.g. clinical signs, elevated creatine kinase, characteristic ECG findings.) For ethical reasons cardiac biopsy was not possible in these patients.[3] In unexplained hyperthermia and perhaps in the first 4 to 6 weeks after starting the treatment with clozapine ECG monitoring would be perhaps recommended. References (1) Tanner MA and Culling W. Clozapine associated dilated cardiomyopathy. Postgrad Med J 2003; 79: 412-413. (2) Kilian,JG et al. Myocarditis and cardiomyopathy associated wih clozapine.Lancet 1999;354:1841-1845. (3) Degner D et al. Myocarditis associated with clozapine treatment Aust N Z J Psychiatry 2000;34:880. |
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