Monitoring Patients With Psychotic Disorders for Clozapine-Induced Myocarditis or Cardiomyopathy

Key Message

Three evidence-based guidelines were identified about the use of clozapine for patients with psychotic disorders.

The included guidelines provide recommendations for testing and assessment of key health parameters for patients who are prescribed clozapine via various means such as laboratory tests and electrocardiogram.

The guidelines provide recommendations of co-prescription for patients who have not responded adequately to an optimized dose of clozapine alone.

Two guidelines offer specific recommendations on clozapine dosing.

The guidelines were generally well developed, clearly reported, and consistent in their recommendations. However, several of the recommendations were derived from sources of evidence that may not be considered of the highest quality, with the strength of recommendation not reported and unclear.

The diagnostic accuracy of high-sensitivity troponin I testing versus troponin T testing for detecting myocarditis or cardiomyopathy in patients receiving clozapine for psychotic disorders is unknown as no relevant evidence was identified.

Given the limited availability and varying quality of evidence, the diagnostic accuracy of high-sensitivity troponin I testing and how best to monitor for clozapine-induced myocarditis and cardiomyopathy in patients with psychotic disorders remains uncertain.