A young man with psychosis whose heart is racing
Mr. C, age 19, is paranoid, anxious, and agitated. After several medication trials, clozapine relieves his psychotic symptoms, but his heart rate is persistently elevated. How would you treat him?
Follow-up appointment with cardiology and repeat echocardiography were scheduled for 6 weeks after discharge. The follow-up echocardiogram showed improvement (LVEF, 50%). Mr. C continues to do well and remains a client at the IOP program.
Bottom Line
Clozapine often is used as a last resort for patients with treatment-resistant schizophrenia, but its side-effect profile requires careful management and monitoring. If a patient taking clozapine shows tachycardia, consider cardiomyopathy. Evaluation might include lab testing, electrocardiography, and echocardiography. Symptoms often resolve when clozapine is discontinued.
Related Resources
• Citrome L. Clozapine for schizophrenia: life-threatening or life-saving treatment? Current Psychiatry. 2009;8(12):56-63.
• Layland JJ, Liew D, Prior DL. Clozapine-induced cardiotoxicity: a clinical update. Med J Aust. 2009;190(4):190-192.
Drug Brand Names
Benztropine • Cogentin Fluphenazine • Prolixin
Chlorpromazine • Thorazine Haloperidol • Haldol
Citalopram • Celexa Lorazepam • Ativan
Clonazepam • Klonopin Metoprolol • Lopressor
Clozapine • Clozaril Olanzapine • Zyprexa
Duloxetine • Cymbalta Quetiapine • Seroquel
Escitalopram • Lexapro Risperidone • Risperdal
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
