抄録
We report a case of clozapine-induced myocarditis in a Japanese man that occurred despite a slow increase in the dose of clozapine. The patient developed myocarditis on day 24 of treatment with clozapine, and his clinical course was complicated by ventricular fibrillation (VF) and permanent brain damage. Clozapine is the only effective antipsychotic against treatment- refractory schizophrenia (TRS). Nevertheless, the administration of this agent is associated with a risk of myocarditis. This risk is higher for East Asians versus other populations; therefore, it is important to titrate clozapine slowly in these populations of patients. The Japanese package insert for clozapine recommends a faster rate of titration than that stated in international guidelines, which may increase the risk of myocarditis. This case suggests that myocarditis can occur even if the dose of clozapine is increased at a markedly slower rate than that recommended in the package insert. Thus, we recommend revision of the Japanese package insert for clozapine to align with the international guidelines. This case also highlights the importance of close monitoring for adverse events in patients receiving treatment with clozapine, even under slow titration.
