Clozapine-Associated Pulmonary Embolism: A High-Mortality, Dose-Independent and Early-Onset Adverse Effect

  title={Clozapine-Associated Pulmonary Embolism: A High-Mortality, Dose-Independent and Early-Onset Adverse Effect},
  author={Nilofar Sarvaiya and Yevgeniya Lapitskaya and Lorena Dima and Peter Manu},
  journal={American Journal of Therapeutics},
Background: Recent epidemiological studies have identified an excess of pulmonary embolism (PE) cases in patients treated with antipsychotic drugs. The findings are particularly relevant for patients treated with clozapine, which has many potentially life-threatening adverse drug effects. Among these adverse drug effects are myocarditis and agranulocytosis that have early onset and are dose independent, but also seizures and myocardial repolarization delay, which are dose dependent and may… 
Clozapine-induced pulmonary embolism in a patient with minimal pre-existing risk factors.
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There is a need for better management of serious clozapine-related adverse events in addition to agranulocytosis, and better education of patients and carers, general practitioners, A&E and ITU staff and others of the problems posed in using clozAPine safely.
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A meta-analysis showed that patients taking the first- or second-generation antipsychotics had a higher risk of venous thromboembolism and pulmonary embolism than those who did not, and low potency first-generation agents increased the risk more than high potency antipsychotic agents.
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Clozapine doses should be personalized for each patient based on pharmacogenetics testing when available and the genetic vulnerability postulates predictors of adverse reactions’ severity; patients with a lower genetic risk could have less frequent hematological monitoring.
Possible involvement of apoptosis in the antipsychotics side effects: A mini‐review
Pro‐ and antiapoptotic or ‘Dr. Jekyll and Mr. Hyde’ effects of antipsychotics, which can be involved in their side effects, as well as their promising therapeutic indications are focused on.
Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism: a Retrospective Study Based on 145 Cases
Valuable information is provided for the prevention and treatment of thrombosis during clinical events and may also be important for alerting forensic examiners to conduct special PTE detection in cases with potential risk factors.
Supportive and palliative care for people with respiratory problems and preexisting serious mental illness.
Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.
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Fatal Venous Thromboembolism Associated with Antipsychotic Therapy
A 47-year-old woman treated with clozapine and paroxetine was admitted to the hospital with dyspnea and swelling of the leg and on hospital day 7, sudden acute respiratory failure developed and the patient died, postmortem examination confirmed the existence of massive PE.
A case of cardiac arrest and pulmonary embolism after clozapine titration.
A case in which a patient was started on clozapine treatment and subsequently developed pericardial tamponade and cardiac arrest complicated by pulmonary embolism is described, consistent with previously described cases of clozAPine-related cardiopulmonary complications that include polyserositis.
Clozapine and pulmonary embolism
A patient with a previous history of pulmonary embolism who developed a new episode of pulmonaryembolism shortly after clozapine treatment was initiated is described, which confirmed a diagnosis of multiple pulmonary emboli.
Clozapine-Induced Pulmonary Embolism: A Case Report and Literature Review
It was concluded that clozapine alone was the cause of pulmonary embolism in this patient and the role of nicotine remains questionable.
Late onset myocarditis with clozapine use
These cases meet the criteria for clozapine-related myocarditis but occur outside the initial high-risk period following commencement (Ronaldson et al., 2010), suggesting the need for ongoing clinical vigilance for symptoms suggestive of myocardritis for the duration of clozAPine treatment.
Clozapine and venous thromboembolism: further evidence.
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A case report of clozapine continuation after pulmonary embolism in the context of other risk factors for thromboembolism
  • Judy Gs Goh, A. John
  • Psychology, Medicine
    The Australian and New Zealand journal of psychiatry
  • 2016
It is important that emergency staff consider emerging psychosis as a potential diagnosis, and it is essential that in those individuals, management aligns with NICE recommendations: antipsychotics should not be used in the neuroleptic-naïve and not in any young person (<16 years.
A New Monitoring Protocol for Clozapine-Induced Myocarditis Based on an Analysis of 75 Cases and 94 Controls
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