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Clozapine treatment frequently causes orthostatic hypotension and sinus tachycardia, and less often QT prolongation, myocarditis and cardiomyopathy.3, 10 Patients taking clozapine must be assessed for cardiac abnormalities before treatment is initiated (Table 2). Once treatment is initiated, reduced fitness, e.g. breathlessness when walking, difficulty breathing at night or oedema may suggest cardiac complications. There is no evidence that regular ECGs or echocardiograms will detect cardiac complications in asymptomatic patients, however, these investigations are useful in confirming a diagnosis.8 Clozapine should be permanently withdrawn if a patient develops myocarditis, cardiomyopathy or QT prolongation greater than 500 milliseconds.8. Orthostatic hypotension may be prevented by the slow initial titration of clozapine dosing. Patients can manage orthostatic hypotension by drinking more fluids (e.g. 1.25 - 2.5 litres of water per day) and modestly increasing their salt intake if appropriate ...
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