{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:45:37Z","timestamp":1791380737606,"version":"4.3.3"},"reference-count":12,"publisher":"MedWorks Media","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"\n Background<\/jats:title>\n Antipsychotic medications are associated with increased cardiovascular morbidity and mortality in patients with serious mental illness (SMI). Clozapine-induced myocarditis and cardiomyopathy are well established; however, emerging pharmacovigilance and observational data suggest that cardiotoxic risk extends beyond clozapine to other antipsychotic agents.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a narrative review of the literature (2000\u20132026), including pharmacovigilance databases (VigiBase, FAERS), cohort studies, case series, and consensus guidelines. Emphasis was placed on epidemiology, mechanisms, comparative risk, clinical presentation, diagnosis, and practical management strategies relevant to psychiatric practice.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Clozapine demonstrates the highest risk of myocarditis (estimated incidence 0.3\u20133%), typically within the first 4\u20138 weeks of treatment. Pharmacovigilance data consistently identify secondary signals for quetiapine and olanzapine, with weaker but present associations for risperidone, aripiprazole, and other agents. Proposed mechanisms include hypersensitivity myocarditis, inflammatory cytokine activation, oxidative stress, and mitochondrial dysfunction. Early recognition through symptom monitoring and selective biomarker use significantly improves outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Cardiotoxicity associated with antipsychotics is not limited to clozapine. Psychiatrists should adopt a risk-stratified approach incorporating cautious titration, early symptom recognition, and targeted monitoring. Greater awareness and multidisciplinary collaboration are essential to optimize both psychiatric and cardiovascular outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.64719\/pb.18531","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T08:56:35Z","timestamp":1780995395000},"page":"124-129","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Clozapine: Myocarditis and Cardiomyopathy Associated with Antipsychotic Medications\u2014An Updated Narrative Review for Psychiatric Practice"],"prefix":"10.64719","volume":"56","author":[{"given":"Mridul","family":"Sarangal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmi","family":"Sarangal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"De Las Cuevas C, Sanz EJ, Ruan CJ et al. Association between myocarditis and antipsychotics other than clozapine: a systematic literature review and a pharmacovigilance study using VigiBase. Expert Opin Drug Saf. 2022;21(4):535\u2013544. doi: 10.1080\/14740338.2022.2035349.","DOI":"10.1080\/14740338.2022.2035349"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"De Las Cuevas C, Sanz EJ, Ruan CJ, de Leon J. Clozapine-associated myocarditis in the World Health Organization\u2019s pharmacovigilance database: focus on reports from various countries. Rev Psiquiatr Salud Ment (Engl Ed). 2022;15(4):238\u2013250. doi: 10.1016\/j.rpsm.2021.07.004.","DOI":"10.1016\/j.rpsm.2021.07.004"},{"key":"ref3","unstructured":"Nguyen LS, Dolladille C, Drici MD et al. Cardiovascular toxicities associated with antipsychotic drugs: a pharmacovigilance study. J Am Coll Cardiol. 2022;79(12):1231\u20131243."},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Ronaldson KJ, Fitzgerald PB, Taylor AJ, Topliss DJ, McNeil JJ. A new monitoring protocol for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Aust N Z J Psychiatry. 2011;45(4):308\u2013315. doi: 10.3109\/00048674.2011.572852.","DOI":"10.3109\/00048674.2011.572852"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ronaldson KJ, Fitzgerald PB, McNeil JJ. Clozapine-induced myocarditis: a widely overlooked adverse reaction. Acta Psychiatr Scand. 2015;132(4):231\u2013240. doi: 10.1111\/acps.12416.","DOI":"10.1111\/acps.12416"},{"key":"ref6","unstructured":"Wagner E, Korman N, Solmi M et al. Multidisciplinary consensus on prevention, screening, and monitoring of clozapine-associated myocarditis and clozapine rechallenge after myocarditis. Br J Psychiatry. 2025;226(1):1\u201310."},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"He L, Deng Y, Li W et al. Characteristics and spectrum of cardiotoxicity induced by antipsychotics. Front Pharmacol. 2022;13:835155. doi: 10.3389\/fphar.2021.835155.","DOI":"10.3389\/fphar.2021.835155"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Daniel P et al. Myocarditis in patients on long-term antipsychotics: mechanisms, management, and recent updates. Heliyon. 2023;9(4):e13714. doi: 10.1016\/j.heliyon.2023.e13714.","DOI":"10.1016\/j.heliyon.2023.e13714"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Correll CU, Solmi M, Veronese N et al. Prevalence, incidence, and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis. World Psychiatry. 2017;16(2):163\u2013180. doi: 10.1002\/wps.20420.","DOI":"10.1002\/wps.20420"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"De Hert M, Correll CU, Bobes J et al. Physical illness in patients with severe mental disorders: prevalence, impact of medications, and disparities in health care. World Psychiatry. 2011;10(1):52\u201377.","DOI":"10.1002\/j.2051-5545.2011.tb00014.x"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Knoph KN, Morgan RJ, Palmer BA et al. Clozapine-induced cardiomyopathy and myocarditis monitoring: a systematic review. Schizophr Res. 2018;199:17\u201324. doi: 10.1016\/j.schres.2018.03.028.","DOI":"10.1016\/j.schres.2018.03.028"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Caforio ALP, Pankuweit S, Arbustini E et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis. Eur Heart J. 2013;34(33):2636\u20132648. doi: 10.1093\/eurheartj\/eht210.","DOI":"10.1093\/eurheartj\/eht210"}],"container-title":["Psychopharmacology Bulletin"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:37:12Z","timestamp":1791315432000},"score":1,"resource":{"primary":{"URL":"https:\/\/medworksmedia.com\/pb-article\/beyond-clozapine-myocarditis-and-cardiomyopathy-associated-with-antipsychotic-medications-an-updated-narrative-review-for-psychiatric-practice\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,4]]}},"URL":"https:\/\/doi.org\/10.64719\/pb.18531","relation":{},"ISSN":["2472-2448"],"issn-type":[{"value":"2472-2448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}