olanzapine and Myocarditis

BACKGROUND Myocarditis is cardiac muscle inflammation caused by infectious or noninfectious agents. Rarely, clozapine, an atypical antipsychotic drug used to treat resistant schizophrenia, has been reported to cause myocarditis, as we report in this case. CASE REPORT A 29-year-old man, who was known to have schizophrenia and was on olanzapine therapy, presented in our Emergency Department with active psychosis, and was subsequently admitted to the psychiatric ward for refractory schizophrenia. He was started on clozapine, which was cross-titrated with olanzapine. On day 20 of being treated with clozapine, he developed a high-grade fever and chest pain. EKG demonstrated new-onset prolonged QT corrected for heart rate (QTc), premature ventricular contractions, ST-T wave changes with an increased ventricular rate, and ventricular bigeminy with elevated troponin and inflammatory markers. Echocardiography showed a reduced left ventricular ejection fraction. Coronary angiography showed normal coronary arteries, low cardiac output, and cardiac index consistent with cardiogenic shock was also observed. Other pertinent laboratory results included negative respiratory viral panel, including COVID-19 PCR, negative blood cultures, and negative stool screen for ova and parasite. Clozapine was discontinued and the patient received management for heart failure with reduced ejection fraction. He improved clinically with return of EKG to normal sinus rhythm and improved left ventricular ejection fraction on repeat echocardiogram. CONCLUSIONS Acute myocarditis can occur due to a myriad of causes, both infectious and noninfectious; thus, determining the lesser-known causes, such as drug-related etiology, is essential to provide appropriate treatment for patients.

Topics: Adult; Clozapine; COVID-19; Humans; Male; Myocarditis; Olanzapine; Schizophrenia; Schizophrenia, Treatment-Resistant; Stroke Volume; Ventricular Function, Left

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Brain; Cardiomyopathies; Child; Clozapine; Dyskinesia, Drug-Induced; Energy Metabolism; Feeding Behavior; Female; Gene Expression; Genetic Association Studies; Humans; Male; Myocarditis; Olanzapine; Pericarditis; Risperidone; Tourette Syndrome; Twin Studies as Topic; Weight Gain

Topics: Antipsychotic Agents; Humans; Myocarditis; Olanzapine; Rhabdomyolysis

Drug-induced eosinophilic myocarditis is a life-threatening and frequently overlooked condition. The prevalence of myocarditis in clozapine-treated patients may be as high as 3 %. An association between olanzapine and myocarditis has not previously been described, but given the chemical similarity between olanzapine and clozapine, we hypothesized the existence of such an association. We searched the spontaneous adverse drug reports database of the Danish Health and Medicines Authority for olanzapine and myocarditis in the period from October 21, 1996 to - June 03, 2015. We identified two fatal cases of eosinophilic myocarditis associated with the use of olanzapine.. Case 1 was a 39-year-old Caucasian man with known substance abuse and schizophrenia. He was found dead in his home. Olanzapine was prescribed at day -54, and dose at time of death was 40 mg/day. Post-mortem toxicological examination demonstrated presence of olanzapine, morphine, venlafaxine and oxazepam. Syringes indicating substance abuse were found in his home. Case 2 was a 36-year-old Caucasian man diagnosed with schizophrenia was found dead unexpectedly. There was no history of substance abuse. Current treatment was olanzapine 20 mg/day +5 mg as PRN (prescribed for almost 4 years), aripiprazole 30 mg/day (prescribed for 6 months) and mirtazapine 30 mg/day (prescribed for 6 months). Both cases of eosinophilic myocarditis were confirmed by autopsy findings and both patients received olanzapine in doses exceeding the recommendations.. Olanzapine may have contributed to and/or worsened the two reported fatal cases of myocarditis. Additional studies are required to establish a causal link between olanzapine and eosinophilic myocarditis.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Eosinophilia; Fatal Outcome; Humans; Male; Myocarditis; Olanzapine; Schizophrenia

A 36 year-old man suffering from schizophrenia was found dead in his apartment. Forensic autopsy was performed due to sudden unexpected death but did not yield the cause of death. Histological examination of the heart showed eosinophilic myocarditis (EM) while forensic chemistry showed a raised level of aripripazol. We discuss the risk of sudden cardiac death in patients receiving antipsychotic drugs and the possible connection between raised drug levels and EM, and we emphasise the importance of autopsy and hope for better means in the future of finding patients at risk.

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Aripiprazole; Autopsy; Benzodiazepines; Death, Sudden, Cardiac; Drug Therapy, Combination; Eosinophilia; Forensic Pathology; Forensic Toxicology; Humans; Male; Mianserin; Mirtazapine; Myocarditis; Myocardium; Olanzapine; Piperazines; Quinolones; Risk Factors

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Hypersensitivity; Humans; Male; Myocarditis; Olanzapine; Psychotic Disorders; Retreatment