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Acta Psychiatr Scand. 2018 Jan;137(1):47-53. doi: 10.1111/acps.12827. Epub 2017 Oct 24.

Adverse cardiac events in out-patients initiating clozapine treatment: a nationwide register-based study.

Author information

1
Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark.
2
Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark.
3
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
4
Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
5
Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
6
Center for Neuropsychiatric Schizophrenia Research (CNSR), Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.
7
Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia.
8
University of Queensland School of Medicine, Brisbane, QLD, Australia.

Abstract

OBJECTIVE:

Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation.

METHOD:

Through nationwide health registers, we identified all out-patients initiating antipsychotic treatment (January 1, 1996-January 1, 2015). Rates of clozapine-associated myocarditis and pericarditis within 2 months from clozapine initiation and rates of cardiomyopathy within 1-2 years from clozapine initiation were compared to rates for other antipsychotics. Mortality within 2 months from clozapine initiation was extracted.

RESULTS:

Three thousand two hundred and sixty-two patients of a total 7932 patients initiated clozapine as out-patients (41.12%). One patient (0.03%) developed myocarditis, and no patients developed pericarditis within 2 months from clozapine initiation. Two (0.06%) and four patients (0.12%) developed cardiomyopathy within 1 and 2 years respectively. Rates were similar for other antipsychotics. Twenty-six patients died within 2 months from clozapine initiation. Pneumonia (23.08%) and stroke (11.54%) were the main causes of death. We estimated the maximum rate of clozapine-associated fatal myocarditis to 0.28%.

CONCLUSION:

Cardiac adverse effects in Danish out-patients initiating clozapine treatment are extremely rare and these rates appear to be comparable to those observed for other antipsychotic drugs.

KEYWORDS:

Danish nationwide registers; antipsychotics; cardiomyopathy; clozapine; mortality; myocarditis; pericarditis

PMID:
29064084
DOI:
10.1111/acps.12827
[Indexed for MEDLINE]

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