Evidence mapPaperPMID 40121574Full record

ArticleCNS drugs2025

Clozapine-Related Tachycardia: An Analysis of Incidence.

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

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Article in CNS drugs, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

5 authors.

Susanna Every-Palmer *Department of Psychological Medicine, University of Otago, Wellington, New Zealand.ORCID 0000-0001-6455-9741
Korinne Northwood *Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.ORCID 0000-0001-6268-547X
James TsakasRoyal Brisbane and Women's Hospital, Metro North, Herston, QLD, Australia.ORCID 0009-0000-0141-5740
Matthew K BurragePA Southside Clinical Unit, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.ORCID 0000-0003-3837-8140
Dan SiskindQueensland Centre for Mental Health Research, Brisbane, QLD, Australia. d.siskind@uq.edu.au.ORCID 0000-0002-2072-9216

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesSinus 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

methodsIn 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.

resultsIn 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.

conclusionsSinus 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.

Indexed as

Antipsychotic AgentsClozapineTachycardiaTachycardia, SinusAdultCross-Sectional StudiesDose-Response Relationship, DrugFemaleHeart RateHumansIncidenceMaleMiddle AgedRisk FactorsYoung AdultAntipsychotic AgentsClozapine

Identifiers

PMID40121574
PMCPMC12058960

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.