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Clozapine-Associated Pericarditis: A Systematic Review 氯氮平相关性心包炎:一项系统综述。
IF 2.5 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-11-01 DOI: 10.1016/j.jaclp.2025.07.004
Aliu Opeyemi Yakubu MD , Olorungbami Kolade Anifalaje MD , Moses Gregory Effiong MD , Oluwakemi Eunice Olalude MD , Maryam Abubakar MD , Francess Oluwaferanmi Adeyemi MD

Background

Clozapine is an atypical antipsychotic for treatment-resistant schizophrenia. Despite its efficacy, it is associated with many serious side effects, including pericarditis. Clozapine-associated pericarditis may range from mild symptoms to life-threatening complications. Despite increasing case reports, a comprehensive synthesis is lacking, necessitating a systematic review.

Objective

To systematically summarize and analyze published case reports of clozapine-assoicated pericarditis with a focus on clinical presentation, diagnostic findings, treatment approaches and patient outcomes.

Methods

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in International Prospective Register of Systematic Reviews. Eight databases, including PubMed, Embase, and PsycINFO, were searched, identifying case reports published between 1980 and 2024. Inclusion criteria focused on English-language case reports diagnosing clozapine-associated pericarditis. Exclusion criteria included nonclozapine-associated pericarditis and mixed etiologies without clozapine-specific data. Data extraction included demographics, clinical presentation, diagnostic findings, management, and outcomes.

Results

The mean age was 33.56 years, with males comprising 63.9%. The most frequent presenting symptoms were chest pain (63.9%) and fever (52.8%), followed by dyspnea (50.0%) and tachycardia (44.4%). Diagnostic tests consistently indicated elevated inflammatory markers, including C-reactive protein (mean: 88.1 mg/dL) and erythrocyte sedimentation rate (mean: 72.7 mm/h). Echocardiograms confirmed pericardial effusion in 88.9% of cases. Management strategies included colchicine (16.7%) and analgesics (19.4%), with cardiac recovery achieved in all but one case. Clozapine rechallenge was attempted in 16.7% of the cases, with successful outcomes in 83.3% of these cases.

Conclusions

Clozapine-associated pericarditis is a rare but serious adverse event characterized by elevated inflammatory markers and diagnostic imaging abnormalities. Prompt recognition and tailored management, including anti-inflammatory treatment and careful rechallenge, can lead to favorable cardiac and psychiatric outcomes.
背景:氯氮平是治疗难治性精神分裂症的非典型抗精神病药物。尽管它很有效,但它有许多严重的副作用,包括心包炎。氯氮平相关性心包炎的症状从轻微到危及生命的并发症不等。尽管病例报告越来越多,但缺乏全面的综合,需要进行系统的审查。方法:按照PRISMA 2020指南进行系统评价,并在PROSPERO注册。检索了包括PubMed、Embase和PsycINFO在内的8个数据库,确定了1980年至2024年间发表的病例报告。纳入标准侧重于诊断氯氮平相关性心包炎的英文病例报告。排除标准包括非氯氮平相关性心包炎和没有氯氮平特异性数据的混合病因。数据提取包括人口统计学、临床表现、诊断结果、管理和结果。结果:平均年龄33.56岁,男性占63.9%。发热(52.8%)、呼吸困难(50%)和心动过速(44.4%)是最常见的症状。诊断试验一致显示炎症标志物升高,包括c反应蛋白(平均值:88.13 mg/dL)和红细胞沉降率(平均值:72.72 mm/hr)。超声心动图证实有88.9%的病例有心包积液。治疗策略包括秋水仙碱(16.7%)和镇痛药(19.4%),除一例外,所有患者心脏均恢复。16.7%的病例尝试氯氮平再挑战,其中83.3%的病例成功。结论:氯氮平相关性心包炎是一种罕见但严重的不良事件,其特征是炎症标志物升高和诊断性影像学异常。及时识别和量身定制的管理,包括抗炎治疗和谨慎的再挑战,可导致良好的心脏和精神预后。
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期刊
Journal of the Academy of Consultation-Liaison Psychiatry
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