{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:39:33Z","timestamp":1778503173039,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"7-8","license":[{"start":{"date-parts":[[2001,7,1]],"date-time":"2001-07-01T00:00:00Z","timestamp":993945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2001,7]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To report a case of sudden cardiac death in a patient receiving combination therapy with clozapine and sertraline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CASE SUMMARY:<\/jats:title>\n                    <jats:p>A 26-year-old white man was discovered dead at his residence. His medical history included chronic paranoid schizophrenia, obsessive\u2014compulsive disorder, major depressive disorder, obstructive sleep apnea, and akathisia. He had no prior history of cardiovascular disease. His medication regimen included clozapine 100 mg twice daily (started 4 y prior to his death), risperidone 3 mg twice daily, sertraline 200 mg once daily, atenolol 50 mg twice daily, and lorazepam 0.5 mg four \u00d7 daily. Autopsy and toxicology studies revealed cardiomegaly suggestive of idiopathic cardiomyopathy, single-vessel coronary artery disease, sertraline and clozapine blood concentrations in the expected range, undetectable lorazepam and risperidone blood concentrations, obesity, and moderate fatty changes to the liver. The most likely cause of death was sudden cardiac death due to acute cardiac arrhythmia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION:<\/jats:title>\n                    <jats:p>Clozapine is structurally similar to the tricyclic antidepressants, which have type 1A antiarrhythmic properties. Case reports have described electrocardiographic abnormalities, cardiomyopathy, and fatal myocarditis associated with its use. Unexplained death in patients on clozapine therapy has also been reported. Sertraline appears to have less cardiac effect; however, one report has observed clinically significant QT prolongation during sertraline therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Clozapine-induced cardiomyopathy and cardiac arrhythmia from clozapine and\/or sertraline use may have contributed to this man's death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.16185","type":"journal-article","created":{"date-parts":[[2003,6,3]],"date-time":"2003-06-03T17:10:23Z","timestamp":1054660223000},"page":"862-866","source":"Crossref","is-referenced-by-count":43,"title":["Sudden Cardiac Death with Clozapine and Sertraline Combination"],"prefix":"10.1177","volume":"35","author":[{"given":"James D","family":"Hoehns","sequence":"first","affiliation":[{"name":"James D Hoehns PharmD BCPS, Assistant Professor (Clinical), College of Pharmacy, The University of Iowa; Clinical Pharmacist, Northeast Iowa Family Practice Residency Program, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle M","family":"Fouts","sequence":"additional","affiliation":[{"name":"Michelle M Fouts PharmD; at time of writing, PharmD Student, The University of Iowa; now, Clinical Pharmacist, Laguna-Honda Hospital, San Francisco, CA; Clinical Assistant Professor, College of Pharmacy, University of California at San Francisco, San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael W","family":"Kelly","sequence":"additional","affiliation":[{"name":"Michael W Kelly PharmD MS, Associate Professor (Clinical), College of Pharmacy, The University of Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie B","family":"Tu","sequence":"additional","affiliation":[{"name":"Katie B Tu PharmD, College of Pharmacy, The University of Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2001,7,1]]},"reference":[{"key":"bibr1-aph.16185","volume-title":"Clozaril 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