Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia.
Acta Psychiatr Scand. 2015 Oct;132(4):231-40. doi: 10.1111/acps.12416. Epub 2015 Apr 11.
We review the published cases of clozapine-induced myocarditis and describe reasons for the higher incidence in Australia (>1%) than elsewhere (<0.1%).
Medline was searched to September 2014 using 'clozapine' as the sole term.
A total of around 250 cases of clozapine-induced myocarditis have been published. Fever among patients commencing clozapine has been reported internationally, and very few of these cases were investigated for myocarditis. The time to onset of fever is consistent with its being part of a prodrome of undiagnosed myocarditis, and the risk factors are similar to those for myocarditis. In more severe cases, clozapine is discontinued, avoiding fatalities which may occur with myocarditis. Furthermore, cases of sudden death and respiratory illness may well have been undiagnosed myocarditis. The diagnosis of myocarditis is confounded by the non-specific nature of the signs and symptoms, and it depends on appropriate investigations being conducted at the time of myocardial involvement or, for fatal cases, the affected area of the myocardium being sampled for histology.
It is likely that the incidence of myocarditis is around 3%. Implementation of monitoring procedures will increase case ascertainment and result in more patients benefiting from this valuable medication.
我们回顾了已发表的氯氮平诱导心肌炎病例，并描述了为何在澳大利亚（>1%）而非其他地区（<0.1%）的发生率更高的原因。
使用“clozapine”作为唯一术语，检索了截至 2014 年 9 月的 Medline。
总共发表了约 250 例氯氮平诱导心肌炎的病例。国际上有报道称，服用氯氮平的患者会出现发热，而这些病例中很少有进行心肌炎检查。发热的出现时间与未确诊心肌炎的前驱期一致，且其危险因素与心肌炎相似。在更严重的情况下，会停用氯氮平，避免因心肌炎而导致的死亡。此外，一些猝死和呼吸疾病病例可能是未确诊的心肌炎。心肌炎的诊断因体征和症状缺乏特异性而变得复杂，这取决于在心肌受累时进行适当的检查，或者对于致命病例，需要对心肌受累区域进行组织学采样。
心肌炎的发病率可能在 3%左右。实施监测程序将增加病例发现，使更多患者受益于这种有价值的药物。
