Reversal of pathologic cardiac parameters after transition from clozapine to olanzapine treatment: a case report
- PMID: 11307047
- DOI: 10.1097/00002826-200103000-00008
Reversal of pathologic cardiac parameters after transition from clozapine to olanzapine treatment: a case report
Abstract
Antipsychotic medications have been associated with significant cardiovascular adverse effects and instances of sudden cardiac death. Recently, we started to evaluate cardiac parameters in medicated patients with schizophrenia using power spectrum analysis of heart rate variability. We present a case of a patient with long-standing schizophrenia who was treated with clozapine. His electrocardiogram revealed minor abnormalities, including a prolonged QT interval. Power spectrum analysis of heart rate variability demonstrated marked abnormalities in autonomic nervous system activity. Two years later, his treatment was switched to olanzapine. We reevaluated his cardiac parameters. Power spectrum analysis studies revealed that heart rate had significantly improved and that power spectrum cardiovascular parameters had returned to normal. Serial electrocardiograms revealed a minimally and asymptomatically prolonged QT interval. This case demonstrates the importance of screening electrocardiograms, even in healthy young patients. It also emphasizes how minor changes in electrocardiogram can be overlooked on standard electrocardiograms. Power spectrum analysis of heart rate variability is useful in this instance because it magnifies the trace and detects even minor disturbances. Care should be taken in prescribing antipsychotic drugs to patients who are prone to cardiovascular side effects, and alternatives to antipsychotics with prominent anticholinergic profile, in particular, should be sought.
Similar articles
-
[Heart rate variability in schizophrenic patients treated with antipsychotic agents].Harefuah. 2001 Dec;140(12):1142-7, 1231. Harefuah. 2001. PMID: 11789296 Hebrew.
-
Analysis of the QTc interval during olanzapine treatment of patients with schizophrenia and related psychosis.J Clin Psychiatry. 2001 Mar;62(3):191-8. doi: 10.4088/jcp.v62n0310. J Clin Psychiatry. 2001. PMID: 11305706 Clinical Trial.
-
Olanzapine versus clozapine in treatment-resistant or treatment-intolerant schizophrenia.Prog Neuropsychopharmacol Biol Psychiatry. 2004 Jan;28(1):173-80. doi: 10.1016/j.pnpbp.2003.09.033. Prog Neuropsychopharmacol Biol Psychiatry. 2004. PMID: 14687871 Clinical Trial.
-
Cardiac safety parameters of olanzapine: comparison with other atypical and typical antipsychotics.J Clin Psychiatry. 2001;62 Suppl 2:35-40. J Clin Psychiatry. 2001. PMID: 11232751 Review.
-
Risperidone versus other atypical antipsychotic medication for schizophrenia.Cochrane Database Syst Rev. 2000;(3):CD002306. doi: 10.1002/14651858.CD002306. Cochrane Database Syst Rev. 2000. PMID: 10908551 Review.
Cited by
-
QTc Interval Prolongation with Therapies Used to Treat Patients with Parkinson's Disease Psychosis: A Narrative Review.Neuropsychiatr Dis Treat. 2021 Dec 24;17:3791-3818. doi: 10.2147/NDT.S324145. eCollection 2021. Neuropsychiatr Dis Treat. 2021. PMID: 34992373 Free PMC article. Review.
-
Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review.Front Neurosci. 2018 Apr 4;12:203. doi: 10.3389/fnins.2018.00203. eCollection 2018. Front Neurosci. 2018. PMID: 29670504 Free PMC article.
-
Clozapine in a patient with treatment-resistant schizophrenia and hypertrophic cardiomyopathy: a case report.BJPsych Open. 2016 Dec 14;2(6):390-393. doi: 10.1192/bjpo.bp.116.003723. eCollection 2016 Nov. BJPsych Open. 2016. PMID: 28138403 Free PMC article.
-
QTc interval prolongation and torsade de pointes associated with second-generation antipsychotics and antidepressants: a comprehensive review.CNS Drugs. 2014 Oct;28(10):887-920. doi: 10.1007/s40263-014-0196-9. CNS Drugs. 2014. PMID: 25168784 Review.
-
Altered heart rate dynamics associated with antipsychotic-induced subjective restlessness in patients with schizophrenia.Neuropsychiatr Dis Treat. 2013;9:989-94. doi: 10.2147/NDT.S48701. Epub 2013 Jul 19. Neuropsychiatr Dis Treat. 2013. PMID: 23986638 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical