Key result
Slow titration enables successful clozapine rechallenge four years after myocarditis in a single patient.
Why the study?
In treatment-resistant schizophrenia, clinicians face questions regarding clozapine rechallenge after clozapine-associated myocarditis, but standardized protocols and published reports of successful rechallenge are lacking.
Can clozapine be safely rechallenged in a patient with a history of clozapine-associated myocarditis using a slow titration protocol?
Can clozapine be safely rechallenged in a patient with a history of clozapine-associated myocarditis using a slow titration protocol?
This case report demonstrates that clozapine rechallenge may be feasible and safe in patients with prior clozapine-associated myocarditis when using a standardized slow titration protocol.
May support cautious clozapine rechallenge with slow titration after myocarditis; leaves open need for prospective trials.
Background Clozapine‐associated myocarditis (CAM) is the most common inflammatory adverse effect under clozapine treatment. In the absence of equally effective therapeutic alternatives for treating treatment‐resistant schizophrenia (TRS), clinicians are often faced with the question of whether to rechallenge clozapine in patients who have experienced CAM. However, there is a lack of standardized protocols and published case reports of successful clozapine rechallenge following CAM. Case Presentation A 40‐year‐old patient diagnosed with paranoid schizophrenia experienced CAM during his first clozapine treatment. Four years later, he was successfully rechallenged using a recently published standardized protocol involving a very slow titration schedule. Conclusions Our case adds to the limited number of published cases of successful clozapine rechallenge following CAM. It is the first published case report to use the rechallenge protocol recently published by Qubad et al. (2024), thereby contributing to the development of standardized protocols for the safe and successful clozapine rechallenge following CAM.
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Zabel et al. (2026) studied this question. Clozapine was successfully rechallenged in a 40-year-old male patient with paranoid schizophrenia four years after experiencing myocarditis using a slow titration protocol.
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