Resolution without discontinuation: heart failure during clozapinetreatment

摘要

Clozapine is an atypical antipsychotic recommended for patients with treatment-resistantschizophrenia whose illness has not responded adequately to treatment despite thesequential use of at least two different antipsychotic drugs at therapeutic doses.Unfortunately, clozapine is frequently discontinued due to both real and perceivedserious, and potentially life-threatening, adverse effects, contributing to theunderutilisation of the most effective treatment in refractory psychotic disorders. Here,we present the case of a 51-year-old man with treatment-resistant schizoaffectivedisorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge.Within 6 months after the clozapine rechallenge, he was diagnosed with heart failurelikely secondary to his antipsychotic treatment. Clozapine-induced heart failure usuallyprompts immediate cessation of treatment. However, in this case, clozapine was continuedwith cardiology consultation. Ramipril and bisoprolol were initiated and the patient’scardiac condition progressively improved over time. Clozapine-induced heart failure is aserious cardiovascular complication of treatment, usually resulting in discontinuation oftreatment. Although there are cases of successful rechallenge, temporary cessation oftreatment can lead to severe psychotic exacerbation and non-engagement with cardiacspecialists. More evidence is required for continued use of clozapine in a patient withclozapine-induced cardiac complications.