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Clozapine-related neutropenia, myocarditis and cardiomyopathy adverse event reports in Australia 1993–2014

A Correction to this article was published on 23 April 2018

This article has been updated

Abstract

Rationale

Clozapine is the gold-standard medicine for treating refractory schizophrenia but there are some notable serious adverse events (AE). We aimed to analyse reported rates of clozapine cardiac and haematological AEs in Australia.

Methods

Using data from the Therapeutic Goods Administration, we examined all reported clozapine AEs (1993–2014) with a specific focus on neutropenia, myocarditis and cardiomyopathy. We related AEs to clozapine-dispensing data in Queensland, scaled up to Australia.

Results

There were 8561 AEs reported: neutropenia (13.7%), myocarditis (9.3%) and cardiomyopathy (3.8%). Reported rates of myocarditis and cardiomyopathy increased after 1999 following a myocarditis case series from Sydney. Cardiomyopathy AE rates have remained stable since then but myocarditis AEs have increased steadily. Neutropenia was more common in women, while cardiomyopathy and myocarditis were more common in men. There were five reported deaths from neutropenia and cardiomyopathy.

Conclusions

The rates of serious AEs (including deaths) are low and likely an underestimate of true rates and need to be considered by clinicians in balancing the risks and benefits. Continued education on the monitoring and treatment of these AEs for consumers, carers and health professionals is essential and reporting these to the relevant national reporting agency is crucial.

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Fig. 1

Change history

  • 23 April 2018

    The authors would like to change the statement found in the results section of the abstract from "There were five reported deaths from neutropenia and cardiomyopathy." to "There were five, 13, and two reported deaths from neutropenia, myocarditis, and cardiomyopathy, respectively."

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Acknowledgements

The authors thank the Therapeutic Goods Administration (TGA) of the Australian Government Department of Health for the data on adverse events. The authors thank Dr. Jenny Curnow from the University of Sydney for reviewing the haematological death cases. We acknowledge the research assistance of Mr. Andrew Kolomensky.

Funding

This study was funded from existing salaries. Dan Siskind is supported in part by an NHMRC Early Career fellowship (APP1111136). This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Correspondence to Samantha A. Hollingworth.

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The authors report no conflicts of interest.

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No ethical approval was required as we used only secondary de-identified data sources.

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Hollingworth, S.A., Winckel, K., Saiepour, N. et al. Clozapine-related neutropenia, myocarditis and cardiomyopathy adverse event reports in Australia 1993–2014. Psychopharmacology 235, 1915–1921 (2018). https://doi.org/10.1007/s00213-018-4881-0

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  • DOI: https://doi.org/10.1007/s00213-018-4881-0

Keywords

  • Clozapine
  • Adverse events
  • Myocarditis cardiomyopathy
  • Neutropenia
  • Agranulocytosis
  • Pharmacovigilance