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Case Reports
. 1999 Nov 27;354(9193):1841-5.
doi: 10.1016/s0140-6736(99)10385-4.

Myocarditis and cardiomyopathy associated with clozapine

Affiliations
Case Reports

Myocarditis and cardiomyopathy associated with clozapine

J G Kilian et al. Lancet. .

Abstract

Background: Clozapine is effective for resistant schizophrenia. After two sudden deaths in physically well young men soon after starting clozapine, we investigated the cardiovascular complications for this drug.

Methods: From January, 1993, to March, 1999, 8000 patients started clozapine treatment in Australia, and were registered with a mandatory monitoring service. We identified cases of myocarditis and cardiomyopathy from voluntary reports to the Australian Adverse Drug Reaction Committee and sought details of the relevant diagnostic studies, necropsies that had been done in suspicious cases, or both.

Findings: 23 cases (20 men, three women, mean age 36 years [SD 9]) were identified: 15 of myocarditis and eight of cardiomyopathy associated with clozapine treatment. Six patients died. All cases of myocarditis (five deaths) occurred within 3 weeks of starting clozapine. Cardiomyopathy (one death) was diagnosed up to 36 months after clozapine was started. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction.

Interpretation: Clozapine therapy may be associated with potentially fatal myocarditis and cardiomyopathy in physically healthy young adults with schizophrenia.

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Comment in

  • Clozapine and sudden death.
    Devarajan S, Kutcher SP, Dursun SM. Devarajan S, et al. Lancet. 2000 Mar 4;355(9206):841; author reply 843. doi: 10.1016/s0140-6736(00)00035-0. Lancet. 2000. PMID: 10711945 No abstract available.
  • Clozapine and sudden death.
    Chan NN. Chan NN. Lancet. 2000 Mar 4;355(9206):841-2; author reply 843. doi: 10.1016/s0140-6736(05)72451-x. Lancet. 2000. PMID: 10711946 No abstract available.
  • Clozapine and sudden death.
    Warner B, Alphs L, Schaedelin J, Koestler T. Warner B, et al. Lancet. 2000 Mar 4;355(9206):842; author reply 843. doi: 10.1016/S0140-6736(05)72452-1. Lancet. 2000. PMID: 10711947 No abstract available.
  • Clozapine and sudden death.
    Suttmann I, Dittert S, Landgraf R, Schulze J, Folwaczny C. Suttmann I, et al. Lancet. 2000 Mar 4;355(9206):842-3; author reply 843. doi: 10.1016/s0140-6736(05)72453-3. Lancet. 2000. PMID: 10711948 No abstract available.

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