氯氮平相关性心肌炎：氯氮平起始时的监测方案及氯氮平再挑战建议。
Clozapine-Associated Myocarditis: A Protocol for Monitoring Upon Clozapine Initiation and Recommendations for How to Conduct a Clozapine Rechallenge.
机构信息
From the Division of Cardiology, Columbia University Irving Medical Center, New York, NY.
Department of Psychiatry.
出版信息
J Clin Psychopharmacol. 2021;41(2):180-185. doi: 10.1097/JCP.0000000000001358.
BACKGROUND
Clozapine is the only medication with Food and Drug Administration approval for treatment-resistant schizophrenia. However, it is underutilized in the United States because of several life-threatening adverse effects, including clozapine-associated myocarditis (CAM), and a limited understanding of how to manage these complications. To date, recommendations for rechallenging patients with CAM that incorporate the cardiac literature or cardioprotective medications have not been developed.
FINDINGS
In this article, we outline a protocol developed with cardiologists and guided by the cardiac literature that provides direction on how to monitor for the initial development of CAM and how to rechallenge patients with CAM. Furthermore, we present 2 successful cases of clozapine rechallenge that were managed using this protocol.
CONCLUSIONS
In both cases, the patients showed marked improvement in their psychiatric symptoms and functioning, demonstrating the importance of considering rechallenge in patients after CAM.
背景
氯氮平是唯一经美国食品药品监督管理局批准用于治疗抵抗性精神分裂症的药物。然而，由于其存在包括氯氮平相关性心肌炎（CAM）在内的多种危及生命的不良反应，且对如何管理这些并发症的认识有限，氯氮平在美国的应用受到限制。迄今为止，尚未制定出纳入心脏文献或心脏保护药物的针对 CAM 患者重新治疗的建议。
发现
在本文中，我们概述了一项与心脏病专家合作制定并以心脏文献为指导的方案，为监测 CAM 的最初发展以及如何对 CAM 患者进行重新治疗提供了指导。此外，我们还介绍了两例使用该方案成功重新治疗氯氮平的病例。
结论
在这两例病例中，患者的精神症状和功能均有显著改善，这表明在 CAM 后考虑重新治疗患者的重要性。
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