Turk Psikiyatri Derg. 2021 Spring;32(1):56-60. doi: 10.5080/u25417.
Clozapine is an important treatment option in patients with treatmentresistant schizophrenia and bipolar disorder. Clozapine has multiple systemic side effects with myocarditis and cardiomyopathy being considered as serious cardiovascular outcomes. Although the aetiology of myocarditis is still unknown, its frequent occurrence in the early stages of clozapine use suggests that type 1 drug hypersensivity may underlie. Although rare, the cardiovascular side effects can be lifethreatening and must be recognized and treated promptly. The nonspecific clinical presentation of these conditions makes risk evaluation and identification of the affected patients difficult. A consensus has not yet been formed on following up the patients without the suspected clinical cardiac symptoms. In this article we presented two cases of myocarditis associated with clozapine. We aimed to emphasize that C-Reactive Protein and troponin monitoring, in accordance with the current clozapine guidelines, was practical and useful for early detection of myocarditis in asymptomatic patients. We also wanted to draw attention to the factors that may increase the cardiovascular risk such as polypharmacy and concomitant use of lithium and valproate with clozapine.
氯氮平是治疗耐药性精神分裂症和双相情感障碍患者的重要选择。氯氮平有多种全身副作用，心肌炎和心肌病被认为是严重的心血管结局。尽管心肌炎的病因仍不清楚，但它在氯氮平早期使用中频繁发生，提示可能存在 1 型药物超敏反应。虽然罕见，但心血管副作用可能危及生命，必须迅速识别和治疗。这些情况的非特异性临床表现使得评估风险和识别受影响的患者变得困难。对于没有可疑临床心脏症状的患者，尚未就后续治疗达成共识。在本文中，我们介绍了两例与氯氮平相关的心肌炎病例。我们的目的是强调根据当前氯氮平指南，监测 C 反应蛋白和肌钙蛋白对于早期检测无症状患者的心肌炎是实用且有用的。我们还想引起人们对可能增加心血管风险的因素的关注，例如与氯氮平合用的多种药物和锂、丙戊酸钠。
