ArticleThe British journal of psychiatry : the journal of mental science2021
Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy.
Article in The British journal of psychiatry : the journal of mental science, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Multidisciplinary consensus on prevention, screening and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis.The British journal of psychiatry : the journal of mental science · 2026Pooled it
- Rational and Translational Implications of D-Amino Acids for Treatment-Resistant Schizophrenia: From Neurobiology to the Clinics.Biomolecules · 2022Pooled it
- Clozapine-induced Myocarditis in Korea: Analysis of a Nationwide Database and Comparison to Other Countries.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2026Article
- Risk factors for sudden cardiac death or sudden unexplained death in patients treated with clozapine: systematic review.BJPsych open · 2026Review
- Reliability of tachycardia as an early warning sign in acute clozapine-induced cardiac inflammation: Protocol for a systematic review.PloS one · 2026Article
- Evolving Trends and Drug Class Dynamics in Drug-Induced Myocarditis: A 2-Decade Comparative Analysis of Pharmacovigilance Data.Journal of the American Heart Association · 2025Article
- Diagnostic algorithm for clozapine-induced myocarditis: A systematic review.World journal of psychiatry · 2025Article
- A Review of Clinical Advances and Challenges in Clozapine-Induced Myocarditis.Neuropsychiatric disease and treatment · 2025Review
- Review
- Developing a validated methodology for identifying clozapine treatment periods in electronic health records.BMC psychiatry · 2024Article
- Reflections on the Lack of Consideration of Ethnic Ancestry to Stratify Clozapine Dosing.Psychiatry investigation · 2023Article
- Coronary Artery Disease in Patients with Severe Mental Illness.Interventional cardiology (London, England) · 2023Review
- Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia.Therapeutic advances in psychopharmacology · 2023Review
- Case Report: Clozapine-Induced Myocarditis in a Patient with Autism Spectrum Disorder and Schizophrenia.Journal of autism and developmental disorders · 2022Article
- Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy - ERRATUM.The British journal of psychiatry : the journal of mental science · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundClozapine is associated with increased risk of myocarditis. However, many common side-effects of clozapine overlap with the clinical manifestations of myocarditis. As a result, there is uncertainty about which signs, symptoms and investigations are important in distinguishing myocarditis from benign adverse effects of clozapine. Clarity on this issue is important, since missing a diagnosis of myocarditis or discontinuing clozapine unnecessarily may both have devastating consequences.
aimsTo examine the clinical characteristics of clozapine-induced myocarditis and to identify which signs and symptoms distinguish true myocarditis from other clozapine adverse effects.
methodA retrospective analysis of the record database for 247 621 patients was performed. A natural language processing algorithm identified the instances of patients in which myocarditis was suspected. The anonymised case notes for the patients of each suspected instance were then manually examined, and those whose instances were ambiguous were referred for an independent assessment by up to three cardiologists. Patients with suspected instances were classified as having confirmed myocarditis, myocarditis ruled out or undetermined.
resultsOf 254 instances in 228 patients with suspected myocarditis, 11.4% (n = 29 instances) were confirmed as probable myocarditis. Troponin and C-reactive protein (CRP) had excellent diagnostic value (area under the curve 0.975 and 0.896, respectively), whereas tachycardia was of little diagnostic value. All confirmed instances occurred within 42 days of clozapine initiation.
conclusionsSuspicion of myocarditis can lead to unnecessary discontinuation of clozapine. The 'critical period' for myocarditis emergence is the first 6 weeks, and clinical signs including tachycardia are of low specificity. Elevated CRP and troponin are the best markers for the need for further evaluation.
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