Clozapine-Related Tachycardia: An Analysis of Incidence.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY

CNS drugs Pub Date : 2025-06-01 Epub Date: 2025-03-23 DOI:10.1007/s40263-025-01177-5

Susanna Every-Palmer, Korinne Northwood, James Tsakas, Matthew K Burrage, Dan Siskind

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引用次数: 0

Abstract

Background and objectives: Sinus tachycardia commonly occurs at the start of clozapine treatment, often leading to discontinuation owing to perceived adverse cardiovascular effects. However, little evidence exists on its natural course after clozapine initiation. We aimed to determine the frequency and course of clozapine-induced tachycardia over the first month of treatment and to identify possible risk factors METHODS: In this cross-sectional study, we serially monitored heart rates (HRs) and other clinical variables of psychiatric inpatients commencing clozapine over the first 28 days. HRs were plotted over time and modelled by explanatory variables, including age group, sex, body mass index (BMI), smoking status and prescribed medications for HR.

Results: In total, 123 consecutive inpatients undergoing clozapine titration were assessed daily, with 2901 HR measures collected. After starting clozapine, mean HR increased from 83.7 to 99.5 beats per minute (bpm). Almost all participants (93.5%) had at least one recorded HR > 100 bpm, and 68% had three consecutive days with HR > 100 bpm (being then defined as tachycardic). At least one HR > 120 bpm was recorded in 35.8%, and 8% had persistent HRs > 120 bpm. Tachycardia occurred early during clozapine titration, with a dose response effect at lower doses, which plateaued between 150 and 350 mg daily. Tachycardia spontaneously resolved for some but 44% remained tachycardic at day 28. Female sex was associated with early tachycardia at day 14 (p = 0.008) but not at day 28, while age, smoking status, and BMI were not significantly associated with tachycardia.

Conclusions: Sinus tachycardia occurred in over two thirds of participants during the first month of clozapine titration. Spontaneous resolution of tachycardia in some suggests watchful monitoring may be appropriate prior to treatment with rate-controlling agents such as β-blockers or ivabradine. Long term follow-up is required to determine the effects of sinus tachycardia on cardiovascular outcomes in patients treated with clozapine.

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氯氮平相关性心动过速：发病率分析。

背景和目的：窦性心动过速通常发生在氯氮平治疗开始时，通常由于心血管不良反应导致停药。然而，很少有证据表明氯氮平开始后其自然过程。我们的目的是确定氯氮平在治疗的第一个月引起的心动过速的频率和过程，并确定可能的危险因素。方法：在这项横断面研究中，我们对精神病住院患者开始使用氯氮平的前28天内的心率（HRs）和其他临床变量进行了连续监测。HR随时间变化，并通过解释变量建模，包括年龄组、性别、体重指数（BMI）、吸烟状况和HR处方药物。结果：共对123例连续接受氯氮平滴定的住院患者进行每日评估，收集2901个HR测量值。开始使用氯氮平后，平均心率从83.7次/分钟增加到99.5次/分钟（bpm）。几乎所有的参与者（93.5%）至少有一次记录的心率> 100 bpm， 68%的人连续三天心率> 100 bpm（然后被定义为心动过速）。35.8%的患者至少有一次HR > 120bpm， 8%的患者有持续的HR > 120bpm。心动过速在氯氮平滴定期间早期发生，在较低剂量下有剂量反应效应，在每日150 - 350 mg之间达到稳定。部分心动过速自行消退，但44%在第28天仍有心动过速。女性与第14天早期心动过速相关（p = 0.008），但与第28天无关，而年龄、吸烟状况和BMI与心动过速无显著相关性。结论：在氯氮平滴定的第一个月，超过三分之二的参与者发生了窦性心动过速。一些患者的心动过速自行消退，提示在使用β受体阻滞剂或伊伐布雷定等限速药物治疗前应进行密切监测。需要长期随访来确定窦性心动过速对氯氮平治疗患者心血管预后的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.