Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings
Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.
Main Authors: | , , , , , , , , , |
---|---|
Format: | Digital revista |
Language: | English |
Published: |
Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del Zulia
2016
|
Online Access: | http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332016000400004 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
id |
oai:scielo:S0535-51332016000400004 |
---|---|
record_format |
ojs |
spelling |
oai:scielo:S0535-513320160004000042017-03-12Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settingsBaptista,TrinoCarrizo,EdgardoRojas,NayibeFernández,ErikaVelaz,GabrielaServigna,MercedesSerrano,AnaSandia,Ignaciode Leon,JoséPérez-Lopresti,Saberio atypical antipsychotics heart toxicity clozapine titration Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.info:eu-repo/semantics/openAccessInstituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del ZuliaInvestigación Clínica v.57 n.4 20162016-12-01info:eu-repo/semantics/articletext/htmlhttp://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332016000400004en |
institution |
SCIELO |
collection |
OJS |
country |
Venezuela |
countrycode |
VE |
component |
Revista |
access |
En linea |
databasecode |
rev-scielo-ve |
tag |
revista |
region |
America del Sur |
libraryname |
SciELO |
language |
English |
format |
Digital |
author |
Baptista,Trino Carrizo,Edgardo Rojas,Nayibe Fernández,Erika Velaz,Gabriela Servigna,Mercedes Serrano,Ana Sandia,Ignacio de Leon,José Pérez-Lopresti,Saberio |
spellingShingle |
Baptista,Trino Carrizo,Edgardo Rojas,Nayibe Fernández,Erika Velaz,Gabriela Servigna,Mercedes Serrano,Ana Sandia,Ignacio de Leon,José Pérez-Lopresti,Saberio Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
author_facet |
Baptista,Trino Carrizo,Edgardo Rojas,Nayibe Fernández,Erika Velaz,Gabriela Servigna,Mercedes Serrano,Ana Sandia,Ignacio de Leon,José Pérez-Lopresti,Saberio |
author_sort |
Baptista,Trino |
title |
Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
title_short |
Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
title_full |
Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
title_fullStr |
Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
title_full_unstemmed |
Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
title_sort |
clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings |
description |
Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care. |
publisher |
Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del Zulia |
publishDate |
2016 |
url |
http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332016000400004 |
work_keys_str_mv |
AT baptistatrino clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT carrizoedgardo clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT rojasnayibe clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT fernandezerika clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT velazgabriela clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT servignamercedes clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT serranoana clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT sandiaignacio clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT deleonjose clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings AT perezloprestisaberio clozapineinducedmyocarditisinobservationalcrosssectionalandfollowupevaluationscomparisonwithotherantipsychoticsinnaturalisticsettings |
_version_ |
1756442818300084224 |