Author(s): Merrill DB, Lieberman JA, Bradford JM, Ahmari SE
The prototypical second-generation antipsychotic clozapine has been associated with various hematologic and metabolic adverse effects. Less attention has been given to clozapine’s adverse cardiac effects, including myocarditis and cardiomyopathy, despite a high associated mortality rate. Here we present the case of a young man with psychosis who developed near-fatal myocarditis after the initiation of clozapine. We review the diagnosis, management, and hypothesized pathophysiology of clozapine-induced myocarditis. We urge clinicians to be vigilant for the condition and to balance the risk of myocarditis and other side effects against the many benefits of clozapine for patients with treatment-resistant symptoms of schizophrenia.