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Clozapine‐induced cardiotoxicity: a clinical update

Clozapine is a valuable drug for patients with treatment‐resistant schizophrenia. Myocarditis is the most publicised cardiac complication of clozapine treatment, but cardiomyopathy and pericarditis have also been reported. Myocarditis has heterogeneous and non‐specific presenting features, making it difficult to identify patients with clozapine‐related myocarditis clinically. A high index of suspicion is required. The gold standard for diagnosis of myocarditis is an endomyocardial biopsy, but this is not a practical initial approach. Transthoracic echocardiography is a valuable, reproducible and widely available tool to assist in diagnosis of clozapine‐induced cardiotoxicity. The level of B‐type natriuretic peptide, a hormone secreted in response to ventricular wall stress, may be useful for evaluating patients with clozapine‐induced cardiac dysfunction and may in the future be useful for screening asymptomatic patients. The mainstay of treatment of clozapine‐induced cardiotoxicity is cessation of clozapine and provision of supportive care.