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Multidisciplinary consensus on prevention, screening and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis.

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Title: Multidisciplinary consensus on prevention, screening and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis.
Authors: Wagner, Elias (AUTHOR), Korman, Nicole (AUTHOR), Solmi, Marco (AUTHOR), Mortazavi, Matin (AUTHOR), Aminifarsani, Zahra (AUTHOR), Dubrovin Leão, Douglas (AUTHOR), Burrage, Matthew K. (AUTHOR), Siskind, Dan (AUTHOR), McMahon, Laura (AUTHOR), Howes, Oliver D. (AUTHOR), Correll, Christoph U. (AUTHOR), Hasan, Alkomiet (AUTHOR)
Source: British Journal of Psychiatry. Apr2026, Vol. 228 Issue 4, p348-356. 9p.
Subjects: Clozapine, Myocarditis, Medical screening, Preventive medicine, Safety, Consensus (Social sciences), Medical quality control
Abstract: Background: Clozapine is the antipsychotic of choice for people with treatment-resistant schizophrenia (TRS) but is associated with the uncommon but potentially life-threatening adverse effect of myocarditis. However, there are no criteria for diagnosing clozapine-associated myocarditis (CAM) or global guidelines on detection and risk reduction, or for restarting clozapine after CAM. Aims: To develop criteria for CAM and algorithms for clozapine initiation and clozapine rechallenge after CAM in a multiprofessional consensus process. Method: We conducted a systematic literature search for cases of clozapine rechallenge following CAM using the PubMed, EMBASE, CINAHL and PsycINFO databases, followed by a multidisciplinary international two-step Delphi consensus process in July and October 2024. The Delphi panel comprised psychiatrists, cardiologists, pharmacists, psychopharmacologists and nurses with expertise on clozapine or myocarditis. Results: Ninety-three clinicians and academics with experience in prescribing clozapine from six continents participated in the Delphi process. A consensus was reached on a definition of CAM according to modified clinical criteria from the European Society of Cardiology for myocarditis associated with immune checkpoint inhibitors. Titration schemes slower than those given in the Summary of Product Characteristics for clozapine were recommended to minimise CAM risk. Minimum and enhanced requirements for screening and monitoring were developed to account for global perspectives and limited resources in certain healthcare systems, and an approach to clozapine rechallenge was elaborated. Conclusions: This multidisciplinary project represents the first guidance for CAM and will inform clinicians, other caregivers and patients, as well as facilitating the development of national guidelines on CAM prevention, screening and monitoring and rechallenge after an index episode of myocarditis in individuals taking clozapine. [ABSTRACT FROM AUTHOR]
Copyright of British Journal of Psychiatry is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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PubType: Academic Journal
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  Label: Title
  Group: Ti
  Data: Multidisciplinary consensus on prevention, screening and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis.
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  Data: <searchLink fieldCode="AR" term="%22Wagner%2C+Elias%22">Wagner, Elias</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Korman%2C+Nicole%22">Korman, Nicole</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Solmi%2C+Marco%22">Solmi, Marco</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mortazavi%2C+Matin%22">Mortazavi, Matin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Aminifarsani%2C+Zahra%22">Aminifarsani, Zahra</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dubrovin+Leão%2C+Douglas%22">Dubrovin Leão, Douglas</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Burrage%2C+Matthew+K%2E%22">Burrage, Matthew K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Siskind%2C+Dan%22">Siskind, Dan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McMahon%2C+Laura%22">McMahon, Laura</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Howes%2C+Oliver+D%2E%22">Howes, Oliver D.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Correll%2C+Christoph+U%2E%22">Correll, Christoph U.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hasan%2C+Alkomiet%22">Hasan, Alkomiet</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22British+Journal+of+Psychiatry%22">British Journal of Psychiatry</searchLink>. Apr2026, Vol. 228 Issue 4, p348-356. 9p.
– Name: Subject
  Label: Subjects
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  Data: <searchLink fieldCode="DE" term="%22Clozapine%22">Clozapine</searchLink><br /><searchLink fieldCode="DE" term="%22Myocarditis%22">Myocarditis</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+screening%22">Medical screening</searchLink><br /><searchLink fieldCode="DE" term="%22Preventive+medicine%22">Preventive medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Safety%22">Safety</searchLink><br /><searchLink fieldCode="DE" term="%22Consensus+%28Social+sciences%29%22">Consensus (Social sciences)</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+quality+control%22">Medical quality control</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Clozapine is the antipsychotic of choice for people with treatment-resistant schizophrenia (TRS) but is associated with the uncommon but potentially life-threatening adverse effect of myocarditis. However, there are no criteria for diagnosing clozapine-associated myocarditis (CAM) or global guidelines on detection and risk reduction, or for restarting clozapine after CAM. Aims: To develop criteria for CAM and algorithms for clozapine initiation and clozapine rechallenge after CAM in a multiprofessional consensus process. Method: We conducted a systematic literature search for cases of clozapine rechallenge following CAM using the PubMed, EMBASE, CINAHL and PsycINFO databases, followed by a multidisciplinary international two-step Delphi consensus process in July and October 2024. The Delphi panel comprised psychiatrists, cardiologists, pharmacists, psychopharmacologists and nurses with expertise on clozapine or myocarditis. Results: Ninety-three clinicians and academics with experience in prescribing clozapine from six continents participated in the Delphi process. A consensus was reached on a definition of CAM according to modified clinical criteria from the European Society of Cardiology for myocarditis associated with immune checkpoint inhibitors. Titration schemes slower than those given in the Summary of Product Characteristics for clozapine were recommended to minimise CAM risk. Minimum and enhanced requirements for screening and monitoring were developed to account for global perspectives and limited resources in certain healthcare systems, and an approach to clozapine rechallenge was elaborated. Conclusions: This multidisciplinary project represents the first guidance for CAM and will inform clinicians, other caregivers and patients, as well as facilitating the development of national guidelines on CAM prevention, screening and monitoring and rechallenge after an index episode of myocarditis in individuals taking clozapine. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of British Journal of Psychiatry is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1192/bjp.2025.89
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      – Code: eng
        Text: English
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        StartPage: 348
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      – SubjectFull: Clozapine
        Type: general
      – SubjectFull: Myocarditis
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      – SubjectFull: Medical screening
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      – SubjectFull: Preventive medicine
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      – SubjectFull: Safety
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              Text: Apr2026
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              Y: 2026
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