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This is a Literature Review study.

August 22, 2025

Management of cardiac adverse effects of clozapine

Key Points

Clozapine administration is linked to significant cardiac adverse effects that require careful management and monitoring.
Notable cardiac issues include myocarditis and cardiomyopathy, which can contribute to severe complications if left unaddressed.
Management strategies for clozapine-induced cardiac effects include adherence to international diagnostic and monitoring protocols.
Understanding the pathophysiology of these cardiac effects supports improved clinical outcomes for patients with treatment-resistant schizophrenia.

Abstract

SUMMARY Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, supported by guidelines from the National Institute for Health and Care Excellence (NICE) and other authorities. However, clozapine is still underutilised for treatment-resistant schizophrenia, despite its proven benefits, including reduced all-cause mortality. This is attributed mainly to its association with adverse effects, including cardiac adverse effects. This review focuses on the latter, with a detailed exploration of clozapine-induced myocarditis – a potentially fatal acute hypersensitivity reaction – and cardiomyopathy, tachycardia and conduction deficits. Among other things, we discuss their pathophysiology, diagnosis and management, with signposting to international diagnostic criteria and monitoring protocols.

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