A 30-year-old schizofrenic man has been successfully treated with clozapine for approximately one a

Fråga: A 30-year-old schizofrenic man has been successfully treated with clozapine for approximately one and a half years. He has now had an episode of chest pain and he has unspecific ECG changes, but no signs of myocardial infarction. Can the symptoms and/or the ECG changes be caused by clozapine?

Sammanfattning: Cardiovascular side-effects in connection with clozapine treatment have been reported in the literature, but only as single case reports divided on a variety of different signs or symptoms. Prolonged QT interval and negative T waves may occur.

Svar: Questions concerning cardiovascular side-effects of clozapine have previously been answered in Drugline (1-2). ECG changes that may occur during clozapine treatment include prolonged QT interval and negative T-waves, according to the manufacturer (2). The files of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) contain 312 clozapine reports, a majority of which concerns hematological side-effects. Twenty reports, divided on 17 symptoms or diagnoses, concern the cardiovascular system. Reported cardiac side-effects include one case of each of the following: ST segment depression, asystole, myocarditis, palpitations, arythmia and pericarditis and two cases each of heart failure, tachycardia and AV block.

An updated Medline search revealed three case reports: a 26-year-old woman who developed a cardiomyopathy after 6 months of clozapine treatment (3), a 34-year-old man with clozapine-related hypertension (4) and finally a 48-year-old man who had an episode with syncope and ST segment elevations, without pain or any increase in creatinine phosphokinase as signs of myocardial infarction, approximately three weeks after starting clozapine treatment (5).

We recommend this case be reported to SADRAC, should no other explanation to the symptoms be revealed.