Three weeks after starting clozapine for treatment-resistant schizophrenia, a 24-year-old man develops fever, pleuritic chest pain, tachycardia, and dyspnoea. Troponin I is mildly elevated and the erythrocyte sedimentation rate is raised. What is the correct action?
- A Continue clozapine with weekly troponin monitoring
- B Reduce the clozapine dose by half
- C Immediately discontinue clozapine ✓
- D Start a beta blocker and reassess in two weeks
Correct answer: C. Immediately discontinue clozapine
Explanation
Clozapine-induced myocarditis typically occurs within the first 4 to 6 weeks of initiation and presents with fever, chest pain, tachycardia, and elevated inflammatory markers and troponin. It can progress rapidly to fatal cardiomyopathy or heart failure, so the drug must be stopped at once and cardiology consulted. Dose reduction or continued monitoring is inappropriate because the reaction is immune mediated and dose cessation, not titration, is required.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.