Clozapine Induced Myocarditis and Pericarditis: An Analysis of Two Illustrative Cases

OBJECTIVES: Clozapine is regarded as the gold standard pharmacotherapy agent for treatment-resistant schizophrenia patients. However, myocarditis and pericarditis, which are significant life-threatening side effects of clozapine, should be closely monitored. These side effects frequently manifest with subtle and insidious symptoms that can be easily misinterpreted as psychiatric symptoms, thereby complicating their identification. Consequently, a high level of clinical awareness and suspicion is imperative. METHODS: Cases of clozapine-associated myocarditis and pericarditis are presented in this study. Following a detailed examination of the electronic records, the patient data are presented. RESULTS: In the first case, tachycardia, hypertension, elevated C-reactive protein (CRP) and troponin T levels, and echocardiographic findings indicative of myocarditis led to a diagnosis of myocarditis. In the second patient, flu-like symptoms, electrocardiogram changes, elevated CRP levels on day 10, and the presence of effusion on echocardiography, but without troponin elevation, led to a diagnosis of pericarditis. In both cases, due to early suspicion, a cardiology consultation was requested, followed by further investigations as recommended, resulting in the diagnoses. Immediate discontinuation of clozapine resulted in rapid resolution of systemic inflammation and normalization of vital signs. CONCLUSIONS: These cases emphasize the dual necessity of clozapine monitoring: early identification and management of cardiac complications, and the judicious approach to discontinuation, avoiding premature cessation based on nonspecific findings. Timely, multidisciplinary evaluation is integral to ensuring cardiac safety and uninterrupted psychiatric treatment.