Clozapine-induced cardiomyopathy and myocarditis monitoring: A systematic review

Kristen N. Knoph, Robert J. Morgan, Brian A. Palmer, Kathryn M. Schak, Amanda C. Owen, Megan R. Leloux, Mayur Patel, Jonathan G. Leung

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The use of clozapine requires monitoring the absolute neutrophil count because of the risk of agranulocytosis, but other potentially fatal adverse events associated with clozapine (specifically, myocarditis and cardiomyopathy) do not have mandatory procedures. We performed a systematic review of English-language articles to synthesize an evidence-based approach for myocarditis and cardiomyopathy monitoring. Articles published from January 1988 through February 2017 were identified through a search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Google Scholar. Selected articles were required to relate to myocarditis or cardiomyopathy in humans from exposure to clozapine. A total of 144 articles were included. Recommendations varied widely. Some authors recommended baseline laboratory monitoring, with or without follow-up testing, for C-reactive protein, creatine kinase MB, and troponin. Electrocardiography was commonly recommended, and echocardiography was less commonly recommended. The expense of monitoring was a consideration. A unanimous recommendation was to stop the use of clozapine and seek a cardiovascular consultation if myocarditis or cardiomyopathy is suspected. Although there is general agreement on which tests to perform for confirming myocarditis and cardiomyopathy, preemptive screening for these clozapine-induced conditions is controversial, and cost and barriers for the use of clozapine are concerns. For asymptomatic patients receiving clozapine, testing could include baseline electrocardiography, echocardiography as part of a cardiac consultation if patients have cardiac disease or risk factors, and monitoring of C-reactive protein and troponin as indicated.

Original languageEnglish (US)
JournalSchizophrenia Research
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Clozapine
Myocarditis
Cardiomyopathies
Troponin
C-Reactive Protein
Echocardiography
Electrocardiography
Referral and Consultation
Agranulocytosis
Creatine Kinase
MEDLINE
Protein Kinases
Heart Diseases
Neutrophils
Language
Databases
Costs and Cost Analysis

Keywords

  • Antipsychotic
  • Cardiomyopathy
  • Clozapine
  • Myocarditis
  • Safety
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Knoph, K. N., Morgan, R. J., Palmer, B. A., Schak, K. M., Owen, A. C., Leloux, M. R., ... Leung, J. G. (Accepted/In press). Clozapine-induced cardiomyopathy and myocarditis monitoring: A systematic review. Schizophrenia Research. https://doi.org/10.1016/j.schres.2018.03.006

Clozapine-induced cardiomyopathy and myocarditis monitoring : A systematic review. / Knoph, Kristen N.; Morgan, Robert J.; Palmer, Brian A.; Schak, Kathryn M.; Owen, Amanda C.; Leloux, Megan R.; Patel, Mayur; Leung, Jonathan G.

In: Schizophrenia Research, 01.01.2018.

Research output: Contribution to journalArticle

Knoph, KN, Morgan, RJ, Palmer, BA, Schak, KM, Owen, AC, Leloux, MR, Patel, M & Leung, JG 2018, 'Clozapine-induced cardiomyopathy and myocarditis monitoring: A systematic review', Schizophrenia Research. https://doi.org/10.1016/j.schres.2018.03.006
Knoph, Kristen N. ; Morgan, Robert J. ; Palmer, Brian A. ; Schak, Kathryn M. ; Owen, Amanda C. ; Leloux, Megan R. ; Patel, Mayur ; Leung, Jonathan G. / Clozapine-induced cardiomyopathy and myocarditis monitoring : A systematic review. In: Schizophrenia Research. 2018.
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