clozapine and Edema

Several detailed case reports have described cardiac muscle disorders (cardiomyopathy and myocarditis) in patients treated with quetiapine, some of which have been fatal. The symptoms included shortness of breath and oedema. The disorders sometimes resolved on withdrawal of quetiapine. Quetiapine is chemically similar to clozapine and olanzapine, which are known to sometimes provoke this type of adverse effect. In practice, a patient who develops dyspnoea or other signs of heart failure during quetiapine therapy may benefit if the drug's role is recognised and quetiapine withdrawn.

Topics: Antipsychotic Agents; Cardiomyopathies; Clozapine; Dibenzothiazepines; Dyspnea; Edema; Humans; Myocarditis; Quetiapine Fumarate

Topics: Adult; Antipsychotic Agents; Clozapine; Drug Substitution; Edema; Female; Humans; Parotid Diseases; Parotid Gland; Recurrence; Schizophrenia, Paranoid; Treatment Outcome

A 49-year-old male, known to have been suffering from paranoid schizophrenia for 10 years, was treated twice with clozapine. Although the clozapine alleviated his psychosis, the patient developed peri-orbital oedema repeatedly. As a result he requested a switch to a different antipsychotic. Also, while the patient was on clozapine, it proved difficult to regulate his hypertension. A possible explanation for these two side-effects is that clozapine blocks the renal dopamine D4 receptor, preventing it from performing its normal natriuretic and diuretic function. In view of the high but largely unnoticed incidence of hypertension in patients on clozapine (4%), we advise that such patients should receive structured somatic screening in a clinical setting.

Topics: Antipsychotic Agents; Clozapine; Edema; Humans; Hypertension; Male; Middle Aged; Orbital Diseases; Schizophrenia, Paranoid

Topics: Clozapine; Drug Resistance; Edema; Humans; Hypertension; Male; Middle Aged; Orbital Diseases

A 45-year-old woman of Moroccan origin developed a dilated cardiomyopathy during clozapine treatment for a psychosis that did not respond to conventional antipsychotics. The onset of her illness was acute with chest pain. She subsequently developed shortness of breath and oedema of the face and legs. The cardiomyopathy appeared to be partially reversible after the clozapine was halted. Cardiomyopathy during the use of clozapine is rarely described in the literature, although myocarditis is a known complication. The cause of cardiomyopathy during the use of clozapine is not known. Myocarditis might evolve into cardiomyopathy. There are indications that myocarditis is caused by an allergic reaction to clozapine. It is advised that clozapine treatment should only be initiated under the close supervision of a psychiatrist, and that during the use of clozapine one should be alert to the risk of cardiac complications.

Topics: Acute Disease; Antipsychotic Agents; Cardiomyopathy, Dilated; Chest Pain; Clozapine; Edema; Female; Humans; Middle Aged; Remission Induction

Topics: Adult; Antipsychotic Agents; Clozapine; Edema; Humans; Male; Parotid Diseases; Schizophrenia, Paranoid

Topics: Adult; Antipsychotic Agents; Clozapine; Edema; Foot Diseases; Humans; Male; Schizophrenia

Topics: Adult; Benztropine; Clozapine; Edema; Female; Humans; Obsessive-Compulsive Disorder; Parotid Diseases; Sialorrhea

Topics: Adult; Antipsychotic Agents; Clozapine; Edema; Humans; Male; Parotid Diseases; Schizophrenia, Paranoid

Clozapine is a novel antipsychotic that is effective in 30% to 50% of treatment-resistant schizophrenia. It is known to cause sialorrhea in 23% of patients. This phenomenon is paradoxical and poorly understood since clozapine is known to have potent anticholinergic effects. We have observed the development of transient salivary gland swelling in four patients on clozapine therapy. Although not clearly related to sialorrhea, this phenomenon may share a similar pathophysiology.. A retrospective chart review was performed on the 4 of 27 patients started on clozapine treatment during a 6-month period who developed salivary gland swelling.. Four patients, none of whom had previously complained of sialorrhea, developed salivary gland swelling after starting clozapine treatment. In all cases, the swelling resolved within days. A possible etiology may be the formation of a calculus that blocks the duct and causes swelling, which resolves when the stone passes.. Clinicians should be aware that salivary gland swelling may be a possible side effect of clozapine use.

Topics: Adult; Aged; Clozapine; Edema; Female; Humans; Psychotic Disorders; Retrospective Studies; Salivary Duct Calculi; Salivary Gland Diseases; Schizophrenia