Clinical Psychopharmacology and Neuroscience

Korean College of Neuropsychopharmacology (대한정신약물학회)
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Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

  • De Berardis, Domenico (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Fornaro, Michele (Polyedra Research Group) ;
  • Orsolini, Laura (Polyedra Research Group) ;
  • Olivieri, Luigi (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Nappi, Francesco (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Rapini, Gabriella (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Vellante, Federica (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Napoletano, Cosimo (Department of Cardiovascular, Hospital "G. Mazzini") ;
  • Serroni, Nicola (National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini") ;
  • Di Giannantonio, Massimo (Department of Neurosciences and Imaging, University "G. d'Annunzio")
  • Received : 2017.03.27
  • Accepted : 2017.05.03
  • Published : 2018.11.30
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Abstract

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine.

Keywords

References

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