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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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Psychiatry |
| Online Access: | http://dx.doi.org/10.1155/2020/6352175 |
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| author | Samuel Adeyemo Oluwole Jegede Peterson Rabel Saad Ahmed Terence Tumenta Oluwatoyin Oladeji Khanderker Taher |
| author_facet | Samuel Adeyemo Oluwole Jegede Peterson Rabel Saad Ahmed Terence Tumenta Oluwatoyin Oladeji Khanderker Taher |
| author_sort | Samuel Adeyemo |
| collection | DOAJ |
| 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 M2 receptors, presynaptic α2 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 | Article |
| id | doaj-art-3021383fbcb14adb8c732ab977cd6dfa |
| institution | Kabale University |
| issn | 2090-682X 2090-6838 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Psychiatry |
| spelling | doaj-art-3021383fbcb14adb8c732ab977cd6dfa2025-02-03T06:43:33ZengWileyCase Reports in Psychiatry2090-682X2090-68382020-01-01202010.1155/2020/63521756352175Persistent Tachycardia in a Patient on ClozapineSamuel Adeyemo0Oluwole Jegede1Peterson Rabel2Saad Ahmed3Terence Tumenta4Oluwatoyin Oladeji5Khanderker Taher6Department of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USADepartment of Psychiatry, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, New York, USATachycardia 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 M2 receptors, presynaptic α2 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.http://dx.doi.org/10.1155/2020/6352175 |
| spellingShingle | Samuel Adeyemo Oluwole Jegede Peterson Rabel Saad Ahmed Terence Tumenta Oluwatoyin Oladeji Khanderker Taher Persistent Tachycardia in a Patient on Clozapine Case Reports in Psychiatry |
| 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 |
| url | http://dx.doi.org/10.1155/2020/6352175 |
| work_keys_str_mv | AT samueladeyemo persistenttachycardiainapatientonclozapine AT oluwolejegede persistenttachycardiainapatientonclozapine AT petersonrabel persistenttachycardiainapatientonclozapine AT saadahmed persistenttachycardiainapatientonclozapine AT terencetumenta persistenttachycardiainapatientonclozapine AT oluwatoyinoladeji persistenttachycardiainapatientonclozapine AT khanderkertaher persistenttachycardiainapatientonclozapine |