Clozapine-related myocarditis and cardiomyopathy in an Australian metropolitan psychiatric service

Objectives: Myocarditis and cardiomyopathy are rarely reported complications of clozapine treatment. The incidence of clozapine-related myocarditis has been variably reported at between 0.03% and 0.19% of initiations and cardiomyopathy has been reported even less commonly. In our Brisbane-based service, nine of 94 patients initiated on clozapine over the previous 3 years appeared to have experienced myocarditis or cardiomyopathy. The unique co-location of our service with a major cardiothoracic hospital facilitated a review of identified cases to inform decisions regarding clozapine treatment and rechallenge in this service. Method: Cases were identified by survey of psychiatric and cardiac medical staff at The Prince Charles Hospital and subjected to re-evaluation by a multidiscipline consensus panel. The panel compared cases to international reports and identified the clinical features that supported a diagnosis of clozapine-related myocarditis or cardiomyopathy. Results: This process resulted in the stratification of the nine cases into the following categories of diagnostic likelihood: three highly probable, three probable, and two possible cases of clozapine-related myocarditis, and one possible case of clozapine-related cardiomyopathy. Successful clozapine rechallenge/continuation was undertaken in two patients and the panel agreed that this was a viable future option for several other patients. Conclusions: Findings of the panel review supported the initial clinical diagnoses. This confirmed that there was an apparent high incidence of clozapine-related myocarditis within this service, for which there was no clear reason. Mechanisms underlying clozapine-related myocarditis and cardiomyopathy, as well as successful clozapine continuation and rechallenge were considered, but definitive explanations remain unknown. This review highlighted the clinician's role in post-marketing drug surveillance to guide rational management of suspected adverse drug effects

World association for the advancement of veterinary parasitology (WAAVP): Third edition of guideline for evaluating the efficacy of equine anthelmintics

This guideline have been developed to assist in the design, execution, and interpretation of studies to assess the efficacy of anthelmintic drugs against internal parasites of equines, including nematodes, cestodes, and larval instars of Gasterophilus spp. The design and execution of critical and controlled studies are outlined, and their advantages and disadvantages are discussed. Unique considerations for specific target parasites are included. Information is also provided on selection of animals, procedures for randomization, housing, feeding, dosage titration, dosage confirmation and field studies, record keeping and necropsy procedures. Finally, this document includes guidance for group size determination and statistical analysis of study results. This guideline should assist investigators in the evaluation of anthelmintic drugs in horses by using comparable and standardized procedures in studies with appropriate numbers of animals

World association for the advancement of veterinary parasitology (WAAVP): Third edition of guideline for evaluating the efficacy of equine anthelmintics

This guideline have been developed to assist in the design, execution, and interpretation of studies to assess the efficacy of anthelmintic drugs against internal parasites of equines, including nematodes, cestodes, and larval instars of Gasterophilus spp. The design and execution of critical and controlled studies are outlined, and their advantages and disadvantages are discussed. Unique considerations for specific target parasites are included. Information is also provided on selection of animals, procedures for randomization, housing, feeding, dosage titration, dosage confirmation and field studies, record keeping and necropsy procedures. Finally, this document includes guidance for group size determination and statistical analysis of study results. This guideline should assist investigators in the evaluation of anthelmintic drugs in horses by using comparable and standardized procedures in studies with appropriate numbers of animals

Evaluation of the efficacy of emodepside+praziquantel topical solution against cestode ( Dipylidium caninum, Taenia taeniaeformis, and Echinococcus multilocularis ) infections in cats

Emodepside+praziquantel topical solution was developed to provide broad-spectrum anthelmintic activity against gastrointestinal parasites in cats. Eight controlled studies were conducted to evaluate the efficacy of a topical solution of emodepside (3 mg/kg) and praziquantel (12 mg/kg) (Profender®, Bayer AG, Leverkusen, Germany) against feline infections with three species of cestodes. Studies featured naturally acquired infections of Dipylidium caninum or Taenia taeniaeformis, or experimental infections with Echinococcus multilocularis that were placebo-controlled, randomized and blinded. Cats were euthanatized and necropsied between 2 and 11 days after treatment, depending on the target parasite. The efficacy of emodepside+praziquantel topical solution was 100% against D. caninum and T. taeniaeformis, and 98.5- 100% against E. multilocularis. No significant systemic or local adverse reactions to treatment were noted in cats that received the combination. Topical treatment of cats with emodepside+praziquantel topical solution was safe and highly effective against cestode infections