A case report on clozapine-induced ventricular ectopics: a fatal adverse drug reaction
-
Rakesh Kumar
,
Arvind Sharma
,
Navneet Kaur
Abstract
Background
Clozapine is one of the most efficacious antipsychotic drug used for the treatment-resistant schizophrenia; it is sometimes associated with serious adverse reactions like agranulocytosis, myocarditis, cardiac rhythm disturbances, etc.
Case presentation
A 30-year-old patient with a primary diagnosis of paranoid schizophrenia (ICD code - F20.05) was on regular prescription for 6 years. Due to refractoriness, the patient was initiated on tablet clozapine. After 45 days of clozapine therapy, he presented with the complaints of worsening of positive symptoms and sudden falls associated with a brief period of unresponsiveness for which the patient was admitted for evaluation. After stabilization of the patient, it was concluded that he was suffering from ventricular ectopics based upon cardiac investigations like electrocardiogram (ECG) and Holter monitoring. Upon causality assessment between the adverse drug reaction (ADR) and the suspected drug using Naranjo Scale and WHO causality assessment scale, the ADR was found to be probable.
Conclusions
This case report will help to keep physicians vigilant about the rare cardiac side effects of clozapine and to do regular ECG monitoring of the patients who are on clozapine. Moreover, this case report generates the evidence of clozapine-induced arrhythmia, which is needed to be quantified with aggressive study design and there is a need to study the dose-dependent relationship of clozapine-induced arrhythmia.
Acknowledgments
Authors are thankful to Baba Farid University of Health Science, Faridkot, Punjab, India for providing the authors with all the necessary facilities and timely guidance.
Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ institutional review board and competent authorities(PSY/2019).
References
[1] Warnez S, Alessi-Severini S. Clozapine: a review of clinical practice guidelines and prescribing trends. BMC Psychiatry 2014;14:102–4.10.1186/1471-244X-14-102Suche in Google Scholar
[2] Barber S, Olotu U, Corsi M, Cipriani A. Clozapine combined with different antipsychotic drugs for treatment-resistant schizophrenia. Cochr Database Syst Rev 2017;3:CD006324.10.1002/14651858.CD006324.pub3Suche in Google Scholar
[3] Jordan S, Hughes D. Clozapine deaths: monitoring adverse drug reactions. Br Med J 2019;364:1482.10.1136/bmj.l482Suche in Google Scholar
[4] De Berardis D, Rapini G, Olivieri L, Di Nicola D, Tomasetti C, Valchera A, et al. Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine. Ther Adv Drug Saf 2018;9:237–56.10.1177/2042098618756261Suche in Google Scholar
[5] Strinic D, Belosic Halle Z, Luetic K, Nedic A, Petrovic I, Sucic M, et al. BPC 157 counteracts QTc prolongation induced by haloperidol, fluphenazine, clozapine, olanzapine, quetiapine, sulpiride, and metoclopramide in rats. Life Sci 2017;186:66–79.10.1016/j.lfs.2017.08.006Suche in Google Scholar
[6] Kim SJ, Gim MS. Clozapine-related paroxysmal supraventricular tachycardia: a case report. East Asian Arch Psychiatry 2018;28:68–70.Suche in Google Scholar
[7] Ronaldson KJ, Taylor AJ, Fitzgerald PB, Topliss DJ, Elsik M, McNeil JJ. Diagnostic characteristics of clozapine-induced myocarditis identified by an analysis of 38 cases and 47 controls. J Clin Psychiatry 2010;71:976–81.10.4088/JCP.09m05024yelSuche in Google Scholar
[8] Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013;34:2636–48, 48a–d.10.1093/eurheartj/eht210Suche in Google Scholar
[9] Curto M, Girardi N, Lionetto L, Ciavarella GM, Ferracuti S, Baldessarini RJ. Systematic review of clozapine cardiotoxicity. Curr Psychiatry Rep 2016;18:68.10.1007/s11920-016-0704-3Suche in Google Scholar
[10] Otsuka Y, Idemoto K, Hosoda Y, Imamura Y, Aoki T. Clozapine-induced myocarditis: follow-up for 3.5 years after successful retrial. J Gen Fam Med 2019;20:114–7.10.1002/jgf2.239Suche in Google Scholar
[11] Kilian JG, Kerr K, Lawrence C, Celermajer DS. Myocarditis and cardiomyopathy associated with clozapine. Lancet 1999;354:1841–5.10.1016/S0140-6736(99)10385-4Suche in Google Scholar
[12] Ucok A, Yagcioglu EA, Yildiz M, Kaymak SU, Saka MC, Tasdelen R, et al. Reasons for clozapine discontinuation in patients with treatment-resistant schizophrenia. Psychiatry Res 2019;275:149–54.10.1016/j.psychres.2019.01.110Suche in Google Scholar PubMed
[13] Zaki SA. Adverse drug reaction and causality assessment scales. Lung India: Off Organ Indian Chest Soc 2011;28:152–3.10.4103/0970-2113.80343Suche in Google Scholar PubMed PubMed Central
[14] Basu S. Dose-dependent clozapine-induced supraventricular tachycardia. Prim Care Companion CNS Disord 2016;18.10.4088/PCC.15l01867Suche in Google Scholar PubMed PubMed Central
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- Cytoprotective effects of the aqueous extract of the Ziziphus jujuba fruit on TBHP-induced damage on human fibroblast cells
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- A case report on clozapine-induced ventricular ectopics: a fatal adverse drug reaction
