Successful Clozapine Rechallenge in a 40-Year-Old Male Patient With Paranoid Schizophrenia After Clozapine-Associated Myocarditis.

BACKGROUND: Clozapine-associated myocarditis (CAM) is the most common inflammatory adverse effect under clozapine treatment. In the absence of equally effective therapeutic alternatives for treating treatment-resistant schizophrenia (TRS), clinicians are often faced with the question of whether to rechallenge clozapine in patients who have experienced CAM. However, there is a lack of standardized protocols and published case reports of successful clozapine rechallenge following CAM.

CASE PRESENTATION: A 40-year-old patient diagnosed with paranoid schizophrenia experienced CAM during his first clozapine treatment. Four years later, he was successfully rechallenged using a recently published standardized protocol involving a very slow titration schedule.

CONCLUSIONS: Our case adds to the limited number of published cases of successful clozapine rechallenge following CAM. It is the first published case report to use the rechallenge protocol recently published by Qubad et al. (2024), thereby contributing to the development of standardized protocols for the safe and successful clozapine rechallenge following CAM.