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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...

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Autores principales: Adeyemo, Samuel, Jegede, Oluwole, Rabel, Peterson, Ahmed, Saad, Tumenta, Terence, Oladeji, Oluwatoyin, Taher, Khanderker
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
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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.
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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
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