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Re: Proper heart precautions with Clozapine

Posted by ed_uk2010 on February 27, 2015, at 11:12:47

In reply to Re: Proper heart precautions with Clozapine, posted by Lamdage22 on February 27, 2015, at 9:49:10

> Ed,
>
> is cardiomyopathy reversible when it happens with clozapine?

Unlike myocarditis, which normally occurs early during treatment (less than 2 months), cardiomyopathy is generally reported to occur much later in treatment. Cardiomyopathy has a much more gradual onset. It has been reported in 1 out of every 1000 patients treated in Australia, and in 1 out of every 5000 patients treated in the UK. Early on, it may not cause symptoms, eventually - it can cause chronic heart failure.

Echocardiography (an ultrasound scan of the heart) every 6-12 months has been suggested as a way of monitoring for cardiomyopathy. It is not routine practice in the UK but I don't know about elsewhere.

If clozapine is stopped in time, cardiomyopathy is often at least partially reversible. If clozapine is continued, the disorder may progress and have a fatal outcome. As soon as cardiomyopathy is diagnosed, clozapine must be discontinued and medications prescribed to aid cardiac recovery eg. ACE inhibitors etc.

A relatively new blood test called B-type natriuretic peptide (BNP) may be useful to monitor and assess for cardiac dysfunction in those receiving clozapine. Increased levels of BNF show that the heart muscle is under abnormal stress.

 

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