Beta-blocker and angiotensin-converting enzyme inhibitor may limit certain cardiac adverse effects of clozapine

Clozapine is contraindicated in patients who experienced cardiac adverse effects during therapy. A young male (34 years old) with clozapine-responsive schizophrenia developed hypokinetic cardiomyopathy during treatment. The decision to resume clozapine therapy and to treat cardiac problems with carvedilol and captopril was made due to the failure of other antipsychotics to control symptoms. He was followed up for 5 years. Significant improvement of psychiatric conditions and persistence of normal left ventricular function were obtained with combination treatment. β-Blockers and ACE inhibitors may allow resumption of clozapine in refractory schizophrenia in whom it was withdrawn for cardiotoxicity. A large-scale investigation may be useful to confirm the present observations.