{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:32:37Z","timestamp":1793071957751,"version":"4.5.0"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2011,6,1]],"date-time":"2011-06-01T00:00:00Z","timestamp":1306886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Aust N Z J Psychiatry"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:p>Objective: To develop an evidence-based monitoring protocol for clozapine-induced myocarditis.<\/jats:p>\n                  <jats:p>Methods: Potential cases of clozapine-related myocarditis occurring between January 1994 and January 2009 and a comparative group of patients taking clozapine for at least 45 days without cardiac disease were documented from the patients\u2019 medical records.<\/jats:p>\n                  <jats:p>Results: A total of 75 cases and 94 controls were included. Nine cases died. The time to onset was 10\u201333 days with 83% of cases developing between days 14 and 21 inclusive.<\/jats:p>\n                  <jats:p>At least twice the upper limit of normal troponin was found in 90% of cases, but 5 cases had C-reactive protein more than 100 mg\/L and left ventricular impairment by echocardiography without a clinically significant rise in troponin.<\/jats:p>\n                  <jats:p>The proposed monitoring protocol recommends obtaining baseline troponin I\/T, C-reactive protein and echocardiography, and monitoring troponin and C-reactive protein on days 7, 14, 21 and 28. Mild elevation in troponin or C-reactive protein, persistent abnormally high heart rate or signs or symptoms consistent with infective illness should be followed by daily troponin and C-reactive protein investigation until features resolve. Cessation of clozapine is advised if troponin is more than twice the upper limit of normal or C-reactive protein is over 100 mg\/L. Combining these two parameters has an estimated sensitivity for symptomatic clozapine-induced myocarditis of 100%. The sensitivity for asymptomatic disease is unknown.<\/jats:p>\n                  <jats:p>Conclusion: This protocol recommends active monitoring for 4 weeks, relying predominantly on troponin and C-reactive protein results. It encourages continuation of clozapine in the presence of mild illness, but defines a threshold for cessation.<\/jats:p>","DOI":"10.3109\/00048674.2011.572852","type":"journal-article","created":{"date-parts":[[2011,4,27]],"date-time":"2011-04-27T10:44:01Z","timestamp":1303901041000},"page":"458-465","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":210,"title":["A New Monitoring Protocol for Clozapine-Induced Myocarditis Based on an Analysis of 75 Cases and 94 Controls"],"prefix":"10.1177","volume":"45","author":[{"given":"Kathlyn J.","family":"Ronaldson","sequence":"first","affiliation":[{"name":"Department of Epidemiology, and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul B.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Monash Alfred Psychiatric Research Centre, School of Psychology and Psychiatry Alfred Hospital and Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Taylor","sequence":"additional","affiliation":[{"name":"The Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan J.","family":"Topliss","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"McNeil","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,6,1]]},"reference":[{"key":"bibr1-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)10385-4"},{"key":"bibr2-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09m05024yel"},{"key":"bibr3-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2011.01.017"},{"key":"bibr4-00048674.2011.572852","first-page":"68","volume":"121","author":"Hill GR","year":"2008","journal-title":"N Z Med J"},{"key":"bibr5-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61764-X"},{"key":"bibr6-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60742-X"},{"key":"bibr7-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000150217.51433.9f"},{"key":"bibr8-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2004.05.010"},{"key":"bibr9-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-200106000-00004"},{"key":"bibr10-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2005.04.014"},{"key":"bibr11-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1253\/circj.68.734"},{"key":"bibr12-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0800028"},{"key":"bibr13-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcpc079030"},{"key":"bibr14-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200721020-00003"},{"key":"bibr15-00048674.2011.572852","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(06)70965-5"}],"container-title":["Australian &amp; New Zealand Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3109\/00048674.2011.572852","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3109\/00048674.2011.572852","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3109\/00048674.2011.572852","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:53:40Z","timestamp":1777373620000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3109\/00048674.2011.572852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,6]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2011,6]]}},"alternative-id":["10.3109\/00048674.2011.572852"],"URL":"https:\/\/doi.org\/10.3109\/00048674.2011.572852","relation":{},"ISSN":["0004-8674","1440-1614"],"issn-type":[{"value":"0004-8674","type":"print"},{"value":"1440-1614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,6]]}}}