Journal article
Sudden Cardiac Death with Clozapine and Sertraline Combination
The Annals of pharmacotherapy, Vol.35(7-8), pp.862-866
07/2001
DOI: 10.1345/aph.16185
PMID: 11485134
Abstract
OBJECTIVE:
To report a case of sudden cardiac death in a patient receiving combination therapy with clozapine and sertraline.
CASE SUMMARY:
A 26-year-old white man was discovered dead at his residence. His medical history included chronic paranoid schizophrenia, obsessive—compulsive disorder, major depressive disorder, obstructive sleep apnea, and akathisia. He had no prior history of cardiovascular disease. His medication regimen included clozapine 100 mg twice daily (started 4 y prior to his death), risperidone 3 mg twice daily, sertraline 200 mg once daily, atenolol 50 mg twice daily, and lorazepam 0.5 mg four × daily. Autopsy and toxicology studies revealed cardiomegaly suggestive of idiopathic cardiomyopathy, single-vessel coronary artery disease, sertraline and clozapine blood concentrations in the expected range, undetectable lorazepam and risperidone blood concentrations, obesity, and moderate fatty changes to the liver. The most likely cause of death was sudden cardiac death due to acute cardiac arrhythmia.
DISCUSSION:
Clozapine is structurally similar to the tricyclic antidepressants, which have type 1A antiarrhythmic properties. Case reports have described electrocardiographic abnormalities, cardiomyopathy, and fatal myocarditis associated with its use. Unexplained death in patients on clozapine therapy has also been reported. Sertraline appears to have less cardiac effect; however, one report has observed clinically significant QT prolongation during sertraline therapy.
CONCLUSIONS:
Clozapine-induced cardiomyopathy and cardiac arrhythmia from clozapine and/or sertraline use may have contributed to this man's death.
Details
- Title: Subtitle
- Sudden Cardiac Death with Clozapine and Sertraline Combination
- Creators
- James D Hoehns - University of IowaMichelle M Fouts - University of California, San FranciscoMichael W Kelly - University of IowaKatie B Tu - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Annals of pharmacotherapy, Vol.35(7-8), pp.862-866
- Publisher
- SAGE Publications
- DOI
- 10.1345/aph.16185
- PMID
- 11485134
- ISSN
- 1060-0280
- eISSN
- 1542-6270
- Language
- English
- Date published
- 07/2001
- Academic Unit
- Pharmacy Practice and Science
- Record Identifier
- 9984365882602771
Metrics
12 Record Views