{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:08:37Z","timestamp":1759450117887,"version":"build-2065373602"},"reference-count":14,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"5","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>Clozapine is an effective antipsychotic indicated for treatment-resistant schizophrenia (TRS). Its use is limited by its extensive adverse effect profile featuring rare but serious consequences like clozapine-induced myocarditis (CIM). In the event of CIM, clozapine is discontinued; however, there is often no effective alternative for TRS. In this case, a rechallenge of clozapine may be considered. However, there is no standardized protocol to guide clinicians in this process.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Case Report<\/jats:title>\n<jats:p>This report describes the case of a 28-year-old male with a history of CIM who successfully underwent a clozapine rechallenge using a cautious titration protocol described in the literature and reached a daily dose of 150 mg without recurrence of CIM.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Discussion<\/jats:title>\n<jats:p>This case differed from the previously published research protocol in some respects, including the concurrent use of zuclopenthixol for antiaggression and no significant eosinophil-related concerns during monitoring. Despite confounding factors, including concurrent cellulitis affecting inflammatory markers, the patient was successfully rechallenged with clozapine. Limitations of the case include unknown postdischarge outcomes and lack of measurement-based care, such as the use of rating scales, to assess treatment response objectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This case report validates the previously published protocol and contributes to the literature on CIM rechallenge, helping clinicians weigh the risks and benefits of rechallenging clozapine in select patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.9740\/mhc.2025.10.237","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:33:28Z","timestamp":1759322008000},"page":"237-242","source":"Crossref","is-referenced-by-count":0,"title":["Clozapine rechallenge after clozapine-induced myocarditis: A case report to validate a previously published protocol"],"prefix":"10.9740","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6769-3696","authenticated-orcid":true,"given":"Sara J.","family":"Russell","sequence":"first","affiliation":[{"name":"PharmD Student, University of Saskatchewan College of Pharmacy and Nutrition, Saskatoon, Saskatchewan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9731-3992","authenticated-orcid":true,"given":"Matthew","family":"Josdal","sequence":"additional","affiliation":[{"name":"Psychiatry Resident, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8920-5819","authenticated-orcid":true,"given":"Annabelle","family":"Wanson","sequence":"additional","affiliation":[{"name":"Psychiatrist and Area Department Lead (Interim), Saskatchewan Health Authority, Saskatoon, Saskatchewan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6141-0439","authenticated-orcid":true,"given":"Katelyn","family":"Halpape","sequence":"additional","affiliation":[{"name":"(Corresponding author) Associate Professor, University of Saskatchewan College of Pharmacy and Nutrition, Saskatoon, Saskatchewan, katelyn.halpape@usask.ca"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4719","reference":[{"issue":"4","key":"i2168-9709-15-5-237-b01","series-title":"J Can Acad Child Adolesc Psychiatry","first-page":"e252","article-title":"Clozapine-induced myocarditis and subsequent rechallenge: a narrative literature review and case report","volume":"32","author":"Halawa","year":"2023","unstructured":"Halawa N,\nArmstrong M,\nFancy S,\nAbidi S. Clozapine-induced myocarditis and subsequent rechallenge: a narrative literature review and case report. J Can Acad Child Adolesc Psychiatry. 2023;32(4):e252. PMID: 38034406"},{"issue":"9","key":"i2168-9709-15-5-237-b02","series-title":"CNS Drugs","first-page":"671","article-title":"When, why and how to re-challenge clozapine in schizophrenia following myocarditis","volume":"38","author":"Qubad","year":"2024","unstructured":"Qubad M,\nDupont G,\nHahn M,\nMartin SS,\nPuntmann V,\nNagel E, et al. When, why and how to re-challenge clozapine in schizophrenia following myocarditis. CNS Drugs. 2024;38(9):671-96. DOI: 10.1007\/s40263-024-01100-4"},{"issue":"1","key":"i2168-9709-15-5-237-b03","series-title":"Arch Gen Psychiatry","first-page":"82","article-title":"Clozapine treatment for suicidality in schizophrenia: international suicide prevention trial (InterSePT)","volume":"60","author":"Meltzer","year":"2003","unstructured":"Meltzer HY,\nAlphs L,\nGreen AI,\nAltamura AC,\nAnand R,\nBertoldi A, et al. Clozapine treatment for suicidality in schizophrenia: international suicide prevention trial (InterSePT). Arch Gen Psychiatry. 2003;60(1):82-91. DOI: 10.1001\/archpsyc.60.1.82"},{"article-title":"AA-Clozapine Product Monograph [Internet]","year":"2023","key":"i2168-9709-15-5-237-b04","unstructured":"AA-Clozapine Product Monograph [Internet]. AA Pharma Inc; 2023 [cited 2024 Nov 26]. Available from: https:\/\/pdf.hres.ca\/dpd_pm\/00070192.PDF"},{"issue":"5","key":"i2168-9709-15-5-237-b05","series-title":"BMJ Case Rep","first-page":"e248909","article-title":"Successful rechallenge after clozapine-associated myocarditis","volume":"15","author":"Holden","year":"2022","unstructured":"Holden J,\nBegum M. Successful rechallenge after clozapine-associated myocarditis. BMJ Case Rep. 2022;15(5):e248909. DOI: 10.1136\/bcr-2022-248909"},{"issue":"2","key":"i2168-9709-15-5-237-b06","series-title":"J Clin Psychopharmacol","first-page":"180","article-title":"Clozapine-associated myocarditis: a protocol for monitoring upon clozapine initiation and recommendations for how to conduct a clozapine rechallenge","volume":"41","author":"Griffin","year":"2021","unstructured":"Griffin JM,\nWoznica E,\nGilotra NA,\nNucifora Jr FC. Clozapine-associated myocarditis: a protocol for monitoring upon clozapine initiation and recommendations for how to conduct a clozapine rechallenge. J Clin Psychopharmacol. 2021;41(2):180-5. DOI: 10.1097\/JCP.0000000000001358"},{"issue":"7","key":"i2168-9709-15-5-237-b07","series-title":"Can J Psychiatry","first-page":"448","article-title":"Protocol for clozapine rechallenge in a case of clozapine-induced myocarditis","volume":"65","author":"Shivakumar","year":"2020","unstructured":"Shivakumar G,\nThomas N,\nSollychin M,\nTak\u00e1cs A,\nKolamunna S,\nMelgar P, et al. Protocol for clozapine rechallenge in a case of clozapine-induced myocarditis. Can J Psychiatry. 2020;65(7):448-53. DOI: 10.1177\/0706743719892709"},{"key":"i2168-9709-15-5-237-b08","series-title":"Psychiatry Res","first-page":"114247","article-title":"Clozapine-induced myocarditis and patient outcomes after drug rechallenge following myocarditis: a systematic case review","volume":"305","author":"Richardson","year":"2021","unstructured":"Richardson N,\nGreenway SC,\nBousman CA. Clozapine-induced myocarditis and patient outcomes after drug rechallenge following myocarditis: a systematic case review. Psychiatry Res. 2021;305:114247. DOI: 10.1016\/j.psychres.2021.114247"},{"issue":"2","key":"i2168-9709-15-5-237-b09","series-title":"J Clin Psychopharmacol","first-page":"218","article-title":"Successful clozapine rechallenge after suspected clozapine-associated myocarditis: a case report","volume":"41","author":"Danilewitz","year":"2021","unstructured":"Danilewitz M,\nRafizadeh R,\nBousman CA. Successful clozapine rechallenge after suspected clozapine-associated myocarditis: a case report. J Clin Psychopharmacol. 2021;41(2):218-20. DOI: 10.1097\/JCP.0000000000001339"},{"key":"i2168-9709-15-5-237-b10","series-title":"Am J Case Rep","first-page":"e926507","article-title":"Successful clozapine re-challenge after suspected clozapine-induced myocarditis","volume":"21","author":"Hosseini","year":"2020","unstructured":"Hosseini SA,\nSkrzypcak B,\nYasaei R,\nAbdijadid S,\nJoolhar F,\nWin TT, et al. Successful clozapine re-challenge after suspected clozapine-induced myocarditis. Am J Case Rep. 2020;21:e926507-1. DOI:10.12659\/AJCR.926507"},{"issue":"4","key":"i2168-9709-15-5-237-b11","series-title":"J Clin Psychopharmacol","first-page":"380","article-title":"Clozapine-related myocarditis and rechallenge: a case series and clinical review","volume":"39","author":"No\u00ebl","year":"2019","unstructured":"No\u00ebl MC,\nPowell V,\nBurton L,\nPanda R,\nRemington G. Clozapine-related myocarditis and rechallenge: a case series and clinical review. J Clin Psychopharmacol. 2019;39(4):380-5. DOI: 10.1097\/JCP.0000000000001062"},{"key":"i2168-9709-15-5-237-b12","series-title":"Heart Lung Circ","first-page":"S45","article-title":"New monitoring guidelines for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls","volume":"19","author":"Ronaldson","year":"2010","unstructured":"Ronaldson K,\nTaylor A,\nFitzgerald P,\nTopliss D,\nMcNeil J. New monitoring guidelines for clozapine-induced myocarditis based on an analysis of 75 cases and 94 controls. Heart Lung Circ. 2010;19:S45. DOI: 10.1016\/j.hlc.2010.06.772"},{"issue":"2","key":"i2168-9709-15-5-237-b13","series-title":"Acta Psychiatr Belg","first-page":"152","article-title":"Open multicentre trial of zuclopenthixol in mania and schizophrenia based on the AMDP scales","volume":"86","author":"Bobon","year":"1986","unstructured":"Bobon D,\nTroisfontaines B,\nKempeneers JL,\nXhenseval B,\nBourdouxhe S,\nMirel J, et al. Open multicentre trial of zuclopenthixol in mania and schizophrenia based on the AMDP scales. Acta Psychiatr Belg. 1986;86(2):152-76. PMID: 2873713"},{"issue":"5","key":"i2168-9709-15-5-237-b14","series-title":"Exp Ther Med","first-page":"1","article-title":"Association of antipsychotic use with raised eosinophil count","volume":"21","author":"Tsamakis","year":"2021","unstructured":"Tsamakis K,\nMueller C,\nHortis I,\nKallergi M,\nTolos I,\nAlevyzakis E, et al. Association of antipsychotic use with raised eosinophil count. Exp Ther Med. 2021;21(5):1-5. DOI: 10.3892\/etm.2021.9944"}],"container-title":["Mental Health Clinician"],"original-title":[],"link":[{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/15\/5\/article-p237.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mhc.kglmeridian.com\/downloadpdf\/journals\/mhcl\/15\/5\/article-p237.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/mhc.kglmeridian.com\/downloadpdf\/journals\/mhcl\/15\/5\/article-p237.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:32:29Z","timestamp":1759365149000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/15\/5\/article-p237.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":14,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.9740\/mhc.2025.10.237","relation":{},"ISSN":["2168-9709"],"issn-type":[{"type":"electronic","value":"2168-9709"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}