Clozapine is one of the atypical anti-psychotic drugs used in the treatmentof resistant schizophrenia. Although cardiac side-effects are rare, it has beenreported that there may be development of myocarditis, dilated cardiomyopathy,postural orthostatic hypotension and prolonged QT duration. Completeatrioventricular (AV) block is characterized by the inability to transmit allof the atrial signal to the ventricles. Causes may be congenital, idiopathicor acquired which are associated with surgery, infection, or muscle disease.AV block is extremely serious and permanent pacemaker insertion is usuallynecessary for all patients. Complete AV block may develop due to clozapineintoxication through increase in vagal tonus, sinoatrial node (SN) and theinhibition of atrioventricular node signalling. The case presented here is of a15-year old female patient who developed AV total cardiac block associatedwith the taking of clozapine in a suicide attempt.
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1. Young CR, Bowers MB Jr, Mazure CM. Management of the adverse effects of clozapine. Schizophr Bull 1998; 24: 381-390.
2. Rohde C, Polcwiartek C, Kragholm K, Ebdrup BH, Siskind D, Nielsen J. Adverse cardiac events in outpatients initiating clozapine treatment: A nationwide register-based study. Acta Psychiatr Scand 2018: 137: 47-53
3. Killian JG, Kerr K, Lawrence C, Celermajer DS. Myocarditis and cardiomyopathy associated with clozapine. Lancet 1999; 354: 1841-1845.
4. Bellissima BL, Tingle MD, Cicović A, Alawami M, Kenedi C. A systematic review of clozapine-induced myocarditis. Int J Cardiol 2018; 259: 122-129.
5. Knoph KN, Morgan RJ 3rd, Palmer BA, et al. Clozapine-induced cardiomyopathy and myocarditis monitoring: A systematic review. Schizophr Res 2018; 199: 17-30.
6. Hollingworth SA, Winckel K, Saiepour N, Wheeler AJ, Myles N, Siskind D. Clozapine-related neutropenia, myocarditis and cardiomyopathy adverse event reports in Australia 1993-2014. Psychopharmacology (Berl) 2018; 235: 1915-1921.
7. Friedman DM, Duncanson LJ, Glickstein J, Buyon JP. A review of congenital heart block. Images Paediatr Cardiol 2003; 16: 36-48.
8. McEvoy JP, Lieberman JA, Stroup TS, et al; CATIE Investigators. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006; 163: 600-610.
9. Makhoul B, Hochberg I, Rispler S, Azzam ZS. Dilated cardiomyopathy: An unusual complication of clozapine therapy. Nat Clin Pract Cardiovasc Med 2008; 5: 566-570.
10. Haas SJ, Hill R, Krum H, et al. Clozapine-associated myocarditis: A review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993–2003. Drug Saf 2007; 30: 47- 57.
11. Committee on Safety of Medicines.Myocarditis with antipsychotics: Recent cases with clozapine (Clozaril). Curr Prob Pharmacovigilance 1993; 19: 9-10.
12. Reinders J, Parsonage W, Lange D, Potter JM, Plever S. Clozapine-related myocarditis and cardiomyopathy in an Australian metropolitan psychiatric service. Aust N Z J Psychiatry 2004; 38: 915-922.
13. Krobert KA, Andressen KW, Levy FO. Heterologous desensitization is evoked by both agonist and antagonist stimulation of the human 5-HT(7) serotonin receptor. Eur J Pharmacol 2006; 532: 1-10.
14. Sahpaz A, Pehlivan S, Turkkan D, Özdemir Kara D, Alkurt Alkan H. Eosinophilic myocarditis in long term use of antipsychotics: Case series and review of the literature. BullClinPsychopharmacol 2016; 26: 417-421.
15. Vaddadi KS, Soosai E, Vaddadi G. Low blood selenium concentrations in schizophrenic patients on clozapine. Br J Clin Pharmacol 2003; 55: 307-309.