Clozapine associated cardiomyopathy: a cluster of 3 cases

At present, withdrawal of clozapine is the mandatory choice in patients who develop cardiac adverse effects, and in these three patients we did not try to resume treatment. Recent case reports, however, suggest that clozapine might be safely resumed after starting treatment for heart failure in patients with otherwise refractory schizophrenia who develop left ventricular dysfunction. A clinical trial is needed to evaluate if early treatment with b blockers and ACE inhibitors may allow the progression of treatment after the development of mild signs of cardiac toxicity in resistant schizophrenia responsive to clozapine.