clozapine and Heart-Failure

Topics: Antipsychotic Agents; Benzodiazepines; Cardiomyopathies; Catatonia; Clozapine; Heart Failure; Humans; Olanzapine; Rhabdomyolysis

Topics: Adult; Aggression; Clozapine; Fatal Outcome; Female; Heart Failure; Humans; Psychiatric Department, Hospital; Psychomotor Agitation; Psychotic Disorders; Restraint, Physical

Existing knowledge of medicines that increase the risk of an adverse event may be corroborated and augmented by population studies specifically assessing the risk associated with the concurrent use of these medicines and use by patients with existing comorbidity. An American Heart Association review recently identified a variety of medicines that may cause or exacerbate heart failure (HF), many with evidence from limited evaluation of population data. We assessed the risk of first-time HF associated with the use of 50 of these medicines by New Zealand's primary care population.. Case-control study utilising national pharmaceutical use and hospital admissions data 2007-2015; 22,989 patients with first-time HF 2008-2015 were matched with 114 498 control patients. The primary outcome was first-time HF and its association with medicine exposure in the prior 90 days, estimated using conditional logistic regression. We also assessed the risk associated with new use of medicines in the prior month, concurrent use, and in patients with existing comorbidity.. Eleven medicines were significantly associated with HF with several other infrequently used medicines providing signals of increased risk. A high risk was associated with the use of salbutamol (adjusted odds ratio 2.63; 95% CI, 2.48-2.78), clozapine (2.70; 2.46-4.98), diltiazem (1.52; 1.44-1.60), indomethacin (2.51; 1.54-4.10), pioglitazone (1.50; 1.16-1.95), and antifungal medicines. New use of medicines and use of medicine combinations increased this risk in many cases.. Our study provides further evidence to inform cautious use of these medicines in patients with HF or at risk of developing HF.

Topics: Aged; Aged, 80 and over; Albuterol; Antifungal Agents; Case-Control Studies; Clozapine; Diltiazem; Drug Therapy, Combination; Female; Follow-Up Studies; Health Services Needs and Demand; Heart Failure; Hospitalization; Humans; Indomethacin; Male; Middle Aged; New Zealand; Pioglitazone; Primary Health Care; Propensity Score; Risk Factors

A 63-year-old woman with diabetes type II and a history of breast cancer was treated with clozapine for her refractory schizophrenia. She developed a dilated cardiomyopathy with an ejection fraction of 25%, a life-threatening event. The cause of heart failure could be multifactorial, with clozapine, family history, chemotherapy, diabetes type II and/or lithium as possible contributing risk factors. Clozapine was discontinued and the patient was referred to a hospice. Two weeks later, her heart failure slowly improved. Subsequently, she became extremely psychotic with a severe decline in quality of life. Therefore, it was decided to restart clozapine under cardiac monitoring. The patient's psychotic symptoms improved and her heart failure status remained stable for more than a year. Thereafter, a small deterioration was seen in cardiac function. In this case, re-exposure to clozapine was successful for at least 2 years.

Topics: Antipsychotic Agents; Cardiomyopathy, Dilated; Clozapine; Diabetes Mellitus, Type 2; Drug Administration Schedule; Female; Heart Failure; Humans; Middle Aged; Quality of Life; Recurrence; Schizophrenia; Treatment Outcome

This is the case of a young man suffering from schizophrenia and treated with clozapine. He developed acute heart failure associated with pericardial effusion and midventricular dyskinesia with severe systolic dysfunction and left ventricular dilatation at echocardiogram, readily resolved after the suspension of clozapine therapy. The segmental wall motion abnormalities observed at echocardiogram in this case are peculiar and have never been described before. The possible cardiotoxic effects of clozapine have been reported previously in the literature. Because of its serious potential side effects this drug is not considered the first choice for treatment of schizophrenia. Before beginning treatment, patients should undergo a cardiac evaluation, and they should also be periodically followed up with echocardiograms.

Topics: Acute Disease; Antipsychotic Agents; Clozapine; Heart Failure; Humans; Male; Myocardial Contraction; Myocarditis; Pericardial Effusion; Schizophrenia; Ultrasonography; Ventricular Dysfunction; Ventricular Function, Left; Ventricular Function, Right; Young Adult