Citation

Whiskey E, Yuen S, Khosla E, Piper S, O'Flynn D, Taylor D. Ther. Adv. Psychopharmacol. 2020; 10.

Copyright

(Copyright © 2020, SAGE Publishing)

DOI

10.1177/2045125320924786

PMID

unavailable

Abstract

Clozapine is an atypical antipsychotic recommended for patients with treatment-resistant schizophrenia whose illness has not responded adequately to treatment despite the sequential use of at least two different antipsychotic drugs at therapeutic doses. Unfortunately, clozapine is frequently discontinued due to both real and perceived serious, and potentially life-threatening, adverse effects, contributing to the underutilisation of the most effective treatment in refractory psychotic disorders. Here, we present the case of a 51-year-old man with treatment-resistant schizoaffective disorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge. Within 6 months after the clozapine rechallenge, he was diagnosed with heart failure likely secondary to his antipsychotic treatment. Clozapine-induced heart failure usually prompts immediate cessation of treatment. However, in this case, clozapine was continued with cardiology consultation. Ramipril and bisoprolol were initiated and the patient's cardiac condition progressively improved over time. Clozapine-induced heart failure is a serious cardiovascular complication of treatment, usually resulting in discontinuation of treatment. Although there are cases of successful rechallenge, temporary cessation of treatment can lead to severe psychotic exacerbation and non-engagement with cardiac specialists. More evidence is required for continued use of clozapine in a patient with clozapine-induced cardiac complications. © The Author(s), 2020.

Language: en

Keywords

adult; human; mental health; male; case report; psychiatry; suicide attempt; heart failure; lithium; hospitalization; C reactive protein; clozapine; mental disease; clinical article; tachycardia; priority journal; middle aged; acetylsalicylic acid; haloperidol; cardiomyopathy; follow up; olanzapine; risperidone; drug withdrawal; benzodiazepine; valproic acid; heart left ventricle function; heart rate; schizoaffective psychosis; clonazepam; dyspnea; electrocardiography; thorax pain; blood pressure; aripiprazole; kidney function; myocarditis; Article; lansoprazole; drug dose increase; drug dose titration; lung tuberculosis; clinical assessment; heart right bundle branch block; PR interval; heart ejection fraction; ramipril; zuclopenthixol; heart function; systolic heart murmur; vitamin D; troponin; bisoprolol; blood monitoring; distant recurrence free survival; eplerenone; rechallenge; treatment response time