Sudden Cardiac Death with Clozapine and Lorazepam Combination

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Schizophrenia (n=1). Intervention: Clozapine and lorazepam combination. Primary outcome: Sudden cardiac death.

Sriram Ramaswamy; Susan J. Boust; Prizada Sattar; Subhash C. Bhatia; Frederick Petty

doi:10.29046/jjp.019.1.005

January 1, 2005Jefferson Journal of PsychiatryOpen Access

Sudden Cardiac Death with Clozapine and Lorazepam Combination

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Key result

A 31-year-old man with schizophrenia experienced sudden cardiac death, potentially due to the combination of clozapine and lorazepam.

Why the study?

Does the combination of clozapine and lorazepam increase the risk of sudden cardiac death in patients with schizophrenia?

Study Design

Type

Case Report (n=1)

Structured PICO

Does the combination of clozapine and lorazepam increase the risk of sudden cardiac death in patients with schizophrenia?

P

Population

31-year-old white man with schizophrenia

I

Intervention

Clozapine 500 mg at bedtime, lorazepam 0.5 mg three times daily, and levothyroxine 75 mcg once a day

O

Outcome

Sudden cardiac deathsafety

The combination of clozapine and lorazepam may have an enhanced potential for sudden cardiac death due to combined effects on vagal tone, sympathetic activity, and cardiomyopathy risk.

Limitations

Case report cannot prove a direct causal relationship
Lack of EKG or 24-hour Holter monitoring to substantiate the exact cardiac cause
Patient had a history of hypertension
Low postmortem clozapine concentration due to missed doses

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Implication

May warrant caution with clozapine-lorazepam co-prescription; leaves open causal risk in schizophrenia pending controlled data.

Abstract

Objective: To report a case of sudden cardiac death in a patient taking a combination of clozapine and lorazepam. Case summary: A 31-year-old white man with schizophrenia was found dead at his apartment. His medication regimen included clozapine 500 mg at bed time, lorazepam 0.5 mg three times daily and levothyroxine 75 mcg once a day. Autopsy studies revealed cardiac hypertrophy, pulmonary congestion and edema. Discussion: Clozapine therapy may cause cardiomyopathy and reduction in heart rate variability (HRV) indices. Benzodiazepines can reduce vagal tone and increase sympathetic activity. This combination can have an enhanced potential for sudden cardiac death. Conclusions: Clozapine induced cardiomyopathy and arrhythmias from clozapine and/or lorazepam use may have contributed to this man's death.

Discussion

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Cite This Study

Ramaswamy et al. (2005) conducted a case report in Schizophrenia (n=1). Clozapine and lorazepam combination was evaluated on Sudden cardiac death. A 31-year-old man with schizophrenia experienced sudden cardiac death, potentially due to the combination of clozapine and lorazepam.

synapsesocial.com/papers/6a05126b8e0e1d4edb08d91a https://doi.org/10.29046/jjp.019.1.005

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Sudden Cardiac Death with Clozapine and Lorazepam Combination

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sudden Cardiac Death with Clozapine and Lorazepam Combination

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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