Should C-Reactive Protein and Troponin Be Monitored for Early Diagnosis of Clozapine Induced Myocarditis? An Assessment Within the Framework of Two Cases

Clozapine is an important treatment option in patients with treatmentresistant schizophrenia and bipolar disorder. Clozapine has multiple systemic side effects with myocarditis and cardiomyopathy being considered as serious cardiovascular outcomes. Although the aetiology of myocarditis is still unknown, its frequent occurrence in the early stages of clozapine use suggests that type 1 drug hypersensivity may underlie. Although rare, the cardiovascular side effects can be lifethreatening and must be recognized and treated promptly. The nonspecific clinical presentation of these conditions makes risk evaluation and identification of the affected patients difficult. A consensus has not yet been formed on following up the patients without the suspected clinical cardiac symptoms. In this article we presented two cases of myocarditis associated with clozapine. We aimed to emphasize that C-Reactive Protein and troponin monitoring, in accordance with the current clozapine guidelines, was practical and useful for early detection of myocarditis in asymptomatic patients. We also wanted to draw attention to the factors that may increase the cardiovascular risk such as polypharmacy and concomitant use of lithium and valproate with clozapine.