Reintroduction of clozapine after clinical recovery of induced pericarditis
Keywords:
pericarditis, pericardial effusion, clozapine, adverse reactionAbstract
Introduction: Clozapine is recommended for treatment-resistant schizophrenia. Albeit infrequently, clozapine may cause severe cardiology adverse reactions, such as myocarditis and pericarditis, in which case it must be stopped. Nevertheless, if the clinical course of the mental illness gets worse, reintroduction of clozapine may be weighed.Case presentation: We present a case report of a patient diagnosed with pericarditis associated to clozapine, who experienced a remarkable worsening of the course of illness after stopping it. One year later clozapine was successfully reintroduced under hospitalization and strict monitoring of several parameters, and patient clinically improved.
Discussion: Although pericarditis is a rare side effect of clozapine, in those cases in which there is a worsening of psychotic symptoms, its reintroduction is a major dilemma for which there are no specific guidelines.
Conclusion: It’s suggested considering the reintroduction of clozapine (adequately monitored) in clinical cases with similar physical and psychiatric symptoms. Protocols and guidelines for clozapine reintroduction after severe cardiological adverse events are needed.
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References
1.Correll CU, Howes OD. Treatment-resistant schizophrenia: Definition, predictors, and therapy options. J Clin Psychiatry. 2021;7;82(5).
2.WHO – UMC World Health Organization - Upssala Monitoring Center [Internet]. n.d. Upssala Monitoring Center. The use of the WHO-UMC system for standardised case causality assessment. Available from: https://www.who-umc.org/media/164200/who-umc-causality-assessment_new-logo.pdf [Internet; accessed 5.10.2022]
3.Shivakumar G, Thomas N, Sollychin M, Takács A, Kolamunna S, Melgar P, et al. Protocol for clozapine rechallenge in a case of clozapine-induced myocarditis. Can J Psychiatry. 2020;65(7):448-53.
4.Manu P, Lapitskaya Y, Shaikh A, Nielsen J. Clozapine rechallenge after major adverse effects: clinical guidelines based on 259 cases. Am J Ther. 2018;25(2):218-23.
5.Branik E, Nitschke M. Pericarditis and polyserositis as a side effect of clozapine in an adolescent girl. J Child Adolesc Psychopharmacol. 2004;14(2):311-4.
6.Rathore S, Masani ND, Callaghan PO. Clozapine-induced effuso-constrictive pericarditis. Case report and review of the literature. Cardiology. 2007;108(3):183-5.
7.Paul I, Basavaraju V, Narayanaswamy JC, Math SB. Clozapine-induced pericarditis: an overlooked adverse effect. Clin Schizophr Relat Psychoses. 2014;8(3):133-4.
8.Sahyouni C, Hefazi E. Clozapine induced pericarditis: A case report. Psychiatry Res. 2021;305:114250.
9.Markovic J, Momcilov T, Mitrovic D, Ivanovic S, Sekuli S, Stojsic A. Clozapine-induced pericarditis. Afr J Psychiatry (Johannesbg). 2011;14(3):236-8.
10.Johal HK, Barrera A. Clozapine-induced pericarditis: an ethical dilemma. BMJ Case Rep. 2019;20;12(6)
11.Malhotra S, Franco K, Tomford JW, Iqbal R. Polyserositis, acute withdrawal, and relapse after abrupt clozapine discontinuation. Psychosomatics. 2002;43(5):418-20.
12.Kay SE, Doery J, Sholl D. Clozapine associated pericarditis and elevated troponin I. Aust N Z J Psychiatry. 2002;36(1):143-4.
13.Crews MP, Dhillon GS, MacCabe JH. Clozapine rechallenge following clozapine-induced pericarditis. J Clin Psychiatry. 2010;71(7):959-61.
14.Boscutti A, Cereda G, Lazzaretti M, Enrico P, Fiorentini A, Prunas C, et al. Successful clozapine rechallenge after myopericarditis: a case report. Int Clin Psychopharmacol. 2022;1;37(4):179-181.
15.Daly JM, Goldberg RJ, Braman SS. Polyserositis associated with clozapine treatment. Am J Psychiatry. 1992;149(9):1274-5.
2.WHO – UMC World Health Organization - Upssala Monitoring Center [Internet]. n.d. Upssala Monitoring Center. The use of the WHO-UMC system for standardised case causality assessment. Available from: https://www.who-umc.org/media/164200/who-umc-causality-assessment_new-logo.pdf [Internet; accessed 5.10.2022]
3.Shivakumar G, Thomas N, Sollychin M, Takács A, Kolamunna S, Melgar P, et al. Protocol for clozapine rechallenge in a case of clozapine-induced myocarditis. Can J Psychiatry. 2020;65(7):448-53.
4.Manu P, Lapitskaya Y, Shaikh A, Nielsen J. Clozapine rechallenge after major adverse effects: clinical guidelines based on 259 cases. Am J Ther. 2018;25(2):218-23.
5.Branik E, Nitschke M. Pericarditis and polyserositis as a side effect of clozapine in an adolescent girl. J Child Adolesc Psychopharmacol. 2004;14(2):311-4.
6.Rathore S, Masani ND, Callaghan PO. Clozapine-induced effuso-constrictive pericarditis. Case report and review of the literature. Cardiology. 2007;108(3):183-5.
7.Paul I, Basavaraju V, Narayanaswamy JC, Math SB. Clozapine-induced pericarditis: an overlooked adverse effect. Clin Schizophr Relat Psychoses. 2014;8(3):133-4.
8.Sahyouni C, Hefazi E. Clozapine induced pericarditis: A case report. Psychiatry Res. 2021;305:114250.
9.Markovic J, Momcilov T, Mitrovic D, Ivanovic S, Sekuli S, Stojsic A. Clozapine-induced pericarditis. Afr J Psychiatry (Johannesbg). 2011;14(3):236-8.
10.Johal HK, Barrera A. Clozapine-induced pericarditis: an ethical dilemma. BMJ Case Rep. 2019;20;12(6)
11.Malhotra S, Franco K, Tomford JW, Iqbal R. Polyserositis, acute withdrawal, and relapse after abrupt clozapine discontinuation. Psychosomatics. 2002;43(5):418-20.
12.Kay SE, Doery J, Sholl D. Clozapine associated pericarditis and elevated troponin I. Aust N Z J Psychiatry. 2002;36(1):143-4.
13.Crews MP, Dhillon GS, MacCabe JH. Clozapine rechallenge following clozapine-induced pericarditis. J Clin Psychiatry. 2010;71(7):959-61.
14.Boscutti A, Cereda G, Lazzaretti M, Enrico P, Fiorentini A, Prunas C, et al. Successful clozapine rechallenge after myopericarditis: a case report. Int Clin Psychopharmacol. 2022;1;37(4):179-181.
15.Daly JM, Goldberg RJ, Braman SS. Polyserositis associated with clozapine treatment. Am J Psychiatry. 1992;149(9):1274-5.
Published
2023-04-28
How to Cite
1.
Vega Davila D, Acosta Artiles FJ, Pérez Nogales E, Yarnoz Goñi N, Pirez Mora GJ. Reintroduction of clozapine after clinical recovery of induced pericarditis. Rev. Hosp. Psiq. Hab. [Internet]. 2023 Apr. 28 [cited 2026 Jan. 10];20(1):e270. Available from: https://revhph.sld.cu/index.php/hph/article/view/270
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