Transient Clozapine-induced Myocarditis Without Discontinuation of Medication: A Series of 2 Patients

• Published in: Journal of psychiatric practice Vol. 28; no. 2; pp. 170 - 175
• Main Authors: Klein, Nadav, Barnett, Laura, Guirgis, Hossam, Stearns, Walter H.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 03-03-2022
• Subjects: Antipsychotic Agents - adverse effects; Clozapine - adverse effects; Drug-Related Side Effects and Adverse Reactions; Humans; Magnetic Resonance Imaging; Myocarditis - chemically induced; Myocarditis - drug therapy
• ISSN: 1538-1145; 1538-1145
• DOI: 10.1097/PRA.0000000000000618

Clozapine, an antipsychotic medication used to treat treatment-refractory schizophrenia, has been associated with various dangerous side effects, including myocarditis. However, there have been few published cases reporting on patients with clozapine-induced myocarditis confirmed by cardiac magnetic resonance imaging or the management, treatment, and follow-up of these patients.
This report describes 2 cases of patients with treatment-refractory schizophrenia evidencing transient clozapine-induced myocarditis. Detailed information including laboratory values, imaging results, and clinical notes were gathered.
The 2 cases demonstrated differing manifestations of clozapine-induced myocarditis. Both cases showed that such myocarditis can be transient and can be treated clinically with close observation without discontinuation of clozapine.
These cases show that clozapine-induced myocarditis is transient at times and can self-resolve without discontinuation of clozapine. These observations may suggest a change in clinical practice so that, with close observation, we can avoid risking psychiatric decompensation in select patients with a history of treatment-resistant schizophrenia.