To the Editor: Clozapine therapy is a recognised risk factor for myocarditis and cardiomyopathy; however, there are no national guidelines for cardiac monitoring. Similar to many centres in Australia, and consistent with the consensus view from major psychiatric facilities in Victoria,1 our institution’s policy is to monitor patients with a baseline echocardiogram before starting treatment with clozapine, at 6 months and 12 months after starting treatment, and once per year thereafter.
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- 1. Berk M, Fitzsimons J, Lambert T, et al. Monitoring the safe use of clozapine: a consensus view from Victoria, Australia. CNS Drugs 2007; 21: 117-127.
- 2. Kilian JG, Kerr K, Lawrence C, Celermajer DS. Myocarditis and cardiomyopathy associated with clozapine. Lancet 1999; 354: 1841-1845.
- 3. Ronaldson KJ, Fitzgerald PB, Taylor AJ, et al. A new monitoring protocol for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Aust N Z J Psychiatry 2011; 45: 458-465.
We thank Melissa Petrakis, Nga Tran and Danny Liew for assistance with data collection and review of the manuscript.
St Vincent’s Hospital Melbourne has received an investigator-initiated grant from Hospira.