Cargando…
Persistent Tachycardia in a Patient on Clozapine
Tachycardia emergent from clozapine treatment is usually transient, often missed, unreported, and therefore frequently goes untreated resulting in possible premature discontinuation of an otherwise effective treatment. Clozapine-induced tachycardia results from direct effects on the sympathetic nerv...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364267/ https://www.ncbi.nlm.nih.gov/pubmed/32724696 http://dx.doi.org/10.1155/2020/6352175 |
_version_ | 1783559809348403200 |
---|---|
author | Adeyemo, Samuel Jegede, Oluwole Rabel, Peterson Ahmed, Saad Tumenta, Terence Oladeji, Oluwatoyin Taher, Khanderker |
author_facet | Adeyemo, Samuel Jegede, Oluwole Rabel, Peterson Ahmed, Saad Tumenta, Terence Oladeji, Oluwatoyin Taher, Khanderker |
author_sort | Adeyemo, Samuel |
collection | PubMed |
description | Tachycardia emergent from clozapine treatment is usually transient, often missed, unreported, and therefore frequently goes untreated resulting in possible premature discontinuation of an otherwise effective treatment. Clozapine-induced tachycardia results from direct effects on the sympathetic nervous system including the blockade of cardiac muscarinic M(2) receptors, presynaptic α(2) adrenoceptors, and indirect activation of the β adrenoceptors. Unfortunately, there are no clear guidelines for monitoring or treating tachycardia induced by clozapine. We present a case of a 55-year-old man with treatment-resistant schizophrenia initiated on clozapine who developed persistent tachycardia and right bundle branch block in the course of treatment. Tachycardia persisted despite treatment with metoprolol and necessitated a transfer to the intensive care unit. A reduction in clozapine dose with the addition of adjunctive antipsychotic(lurasidone) stabilized the patient's heart rate. This case highlights the need for consistent physical examination and a multidisciplinary-based treatment approach for patients on clozapine. The case also suggests that clozapine dose reduction and combination antipsychotic treatments may preclude the need to discontinue clozapine in patients with persistent tachycardia. |
format | Online Article Text |
id | pubmed-7364267 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-73642672020-07-27 Persistent Tachycardia in a Patient on Clozapine Adeyemo, Samuel Jegede, Oluwole Rabel, Peterson Ahmed, Saad Tumenta, Terence Oladeji, Oluwatoyin Taher, Khanderker Case Rep Psychiatry Case Report Tachycardia emergent from clozapine treatment is usually transient, often missed, unreported, and therefore frequently goes untreated resulting in possible premature discontinuation of an otherwise effective treatment. Clozapine-induced tachycardia results from direct effects on the sympathetic nervous system including the blockade of cardiac muscarinic M(2) receptors, presynaptic α(2) adrenoceptors, and indirect activation of the β adrenoceptors. Unfortunately, there are no clear guidelines for monitoring or treating tachycardia induced by clozapine. We present a case of a 55-year-old man with treatment-resistant schizophrenia initiated on clozapine who developed persistent tachycardia and right bundle branch block in the course of treatment. Tachycardia persisted despite treatment with metoprolol and necessitated a transfer to the intensive care unit. A reduction in clozapine dose with the addition of adjunctive antipsychotic(lurasidone) stabilized the patient's heart rate. This case highlights the need for consistent physical examination and a multidisciplinary-based treatment approach for patients on clozapine. The case also suggests that clozapine dose reduction and combination antipsychotic treatments may preclude the need to discontinue clozapine in patients with persistent tachycardia. Hindawi 2020-07-06 /pmc/articles/PMC7364267/ /pubmed/32724696 http://dx.doi.org/10.1155/2020/6352175 Text en Copyright © 2020 Samuel Adeyemo et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Adeyemo, Samuel Jegede, Oluwole Rabel, Peterson Ahmed, Saad Tumenta, Terence Oladeji, Oluwatoyin Taher, Khanderker Persistent Tachycardia in a Patient on Clozapine |
title | Persistent Tachycardia in a Patient on Clozapine |
title_full | Persistent Tachycardia in a Patient on Clozapine |
title_fullStr | Persistent Tachycardia in a Patient on Clozapine |
title_full_unstemmed | Persistent Tachycardia in a Patient on Clozapine |
title_short | Persistent Tachycardia in a Patient on Clozapine |
title_sort | persistent tachycardia in a patient on clozapine |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364267/ https://www.ncbi.nlm.nih.gov/pubmed/32724696 http://dx.doi.org/10.1155/2020/6352175 |
work_keys_str_mv | AT adeyemosamuel persistenttachycardiainapatientonclozapine AT jegedeoluwole persistenttachycardiainapatientonclozapine AT rabelpeterson persistenttachycardiainapatientonclozapine AT ahmedsaad persistenttachycardiainapatientonclozapine AT tumentaterence persistenttachycardiainapatientonclozapine AT oladejioluwatoyin persistenttachycardiainapatientonclozapine AT taherkhanderker persistenttachycardiainapatientonclozapine |