Cases That Test Your Skills
A young man’s affair of the heart
After several failed antipsychotic trials, clozapine resolves Mr. Z’s delusions and hallucinations, but sudden chest pain, fatigue, and shortness...
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.