A Clinical Conundrum: Cardiac Complications with Covid, Covid Vaccines, and Clozapine

Abstract: Background: We and others surmise that clozapine-induced myocarditis may be more common now that Covid-19 virus is among us. Clozapine, Covid, and the mRNA vaccine used to fight the virus can all independently lead to myocarditis, a potentially fatal sequela. Methods: Molecular mimicry between Covid’s spike proteins can lead to myocardial injury through immunoglobulin E (IgE)-mediated pathways that may reach the alpha myosin. Further, myocardial injury can occur in very rare cases among mRNA-vaccinated individuals. It is also well established that Clozapine used alone appears to cause myocarditis in a subset of patients through the very same IgE-mediated pathway. Therefore, cardiac complications amongst clozapine patients — who've either contracted Covid or received an mRNA vaccine — appear to be happening with greater frequency, based on our observations and that of others. Discussion: We and others surmise that without vaccination, myocarditis has an unacceptably high risk of occurring with the Covid infection, particularly when combined with clozapine use. Alternatively, with the mRNA vaccination, whilst Covid infection itself may be staved off, myocarditis can still occur in rare cases. This can cause a problem for patients already taking clozapine, as both occurrences are passed along the same IgE-mediated hypersensitivity pathways. With this, we suggest that clinicians should advocate and encourage the patient to receive the Novavax vaccine. This traditional sub-unit protein vaccine has strong potential for protecting against Covid without detectable cardiac risks. Finally, we advocate – in a post-covid world -- for greater vigilance of cardiac complications with clozapine.Short Description: Potential changes for practice with clozapine in the post covid worldName of Sponsoring Organization(s): n/a