Focussing on the fundaments – assessing and treating Clozapine Induced Gastrointestinal Hypomotility

Abstract

Background: Clozapine is a second-generation antipsychotic used in treatment-resistant Schizophrenia (TRS). Clozapine Induced Gastrointestinal Hypomotility (CIGH) is the commonest cause of clozapine related death, yet remains under-recognised and under-monitored.

Aims and hypothesis: To review the pharmacological management of CIGH. We hypothesised that pharmacological interventions would reduce the incidence of adverse outcomes associated with CIGH.

Methods: We retrospectively reviewed consecutive patients treated on clozapine over a one year period on a male acute psychiatric ward. Information on patient demographics, CIGH symptomatology, treatment and outcome were extracted.

Results: In total, 14 male patients with a mean age of 43 years (standard deviation 10 years) were included. Of these, 9 patients experienced CIGH during admission, in all cases presenting as constipation. Among patients experiencing CIGH, 8 of 9 (89%) patients received one or more interventions. This was most commonly a stimulant, or osmotic laxative. By discharge, the 8 patients treated were in full remission of CIGH symptoms.

Conclusions: A high proportion of patients treated with clozapine experience CIGH, presenting most commonly as constipation. Whilst potentially life-threatening, CIGH can be successfully treated in an acute inpatient setting. Active monitoring of CIGH symptoms in patients initiated, or reinitiated on clozapine is recommended.

Key points

• A high proportion of patients treated with Clozapine experience constipation, the cardinal feature of Clozapine Induced Gastrointestinal Hypomotility.

• Whilst potentially life-threatening, CIGH can be successfully treated in an acute inpatient setting with simple interventions.

• Active monitoring of CIGH symptoms in patients initiated, or reinitiated on clozapine is recommended.

• Future research on the potential benefit of prophylactic intervention would be beneficial.

Keywords:

• Clozapine
• Schizophrenia
• hypomotility
• side effects
• constipation

Disclosure statement

No conflict of interest to declare.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.