A fatal case of ischemic colitis during clozapine administration

Baptista, Trino

doi:10.1590/1516-4446-2014-1402

Cited by 15 publications

(7 citation statements)

References 5 publications

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“…Constipation can lead to ileus, bowel obstruction, ischemic colitis, gastrointestinal necrosis, toxic megacolon, and death [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The incidence of clozapine-related life-threatening hypomotility from spontaneous reporting data in Australasia was 0.3% [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Shirazi

Stubbs

Gómez

et al. 2016

IJMS

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Constipation is a frequently overlooked side effect of clozapine treatment that can prove fatal. We conducted a systematic review and meta-analysis to estimate the prevalence and risk factors for clozapine-associated constipation. Two authors performed a systematic search of major electronic databases from January 1990 to March 2016 for articles reporting the prevalence of constipation in adults treated with clozapine. A random effects meta-analysis was conducted. A total of 32 studies were meta-analyzed, establishing a pooled prevalence of clozapine-associated constipation of 31.2% (95% CI: 25.6–37.4) (n = 2013). People taking clozapine were significantly more likely to be constipated versus other antipsychotics (OR 3.02 (CI: 1.91–4.77), p < 0.001, n = 11 studies). Meta-regression identified two significant study-level factors associated with constipation prevalence: significantly higher (p = 0.02) rates of constipation were observed for those treated in inpatient versus outpatient or mixed settings and for those studies in which constipation was a primary or secondary outcome measure (36.9%) compared to studies in which constipation was not a specified outcome measure (24.8%, p = 0.048). Clozapine-associated constipation is common and approximately three times more likely than with other antipsychotics. Screening and preventative strategies should be established and appropriate symptomatic treatment applied when required.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Shirazi

Stubbs

Gómez

et al. 2016

IJMS

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“…However, clozapine is associated with a number of other serious side effects, including a range of different cardiovascular [14] and immune sequelae, such as neutropenia, agranulocytosis, and myocarditis [15]. In addition, there is increasing awareness that the gastrointestinal side effects of clozapine, including ileus, fecal impaction, and bowel obstruction, ischemia, necrosis, and perforation, represent a significant threat to health, and may even be fatal [16]. Most commonly, clozapine treatment is associated with rapid weight gain and the development of metabolic syndrome [17,18], and rapid glucose intolerance in preclinical studies [19,20], which strongly increases the risk of developing type 2 diabetes mellitus (DM) and cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Treatment of clozapine-associated weight gain: a systematic review

Whitney

Procyshyn

Fredrikson

et al. 2015

Eur J Clin Pharmacol

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While a number of pharmacological interventions can produce modest weight loss, each may be associated with negative side effects, which should be considered before beginning treatment. Given the pressing need to improve cardiometabolic health in most clozapine-treated patients, substantially more research is needed to develop sound clinical practice guidelines for the treatment of clozapine-associated weight gain.

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“…9 – 11 Mortality from complications secondary to constipation is higher with clozapine than other antipsychotic medications. 12 – 14 These side effects can be explained by the antimuscarinic action of clozapine. Concomitant use of other antidepressants, antipsychotics, poor dietary habits with low fiber diets, and sedentary lifestyle seem to compound this problem.…”

Section: Discussionmentioning

confidence: 99%

Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis – a case report

Oke

Schmidt

Bhattarai

et al. 2015

IMCRJ

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Clozapine is the preferred antipsychotic used for the treatment of resistant schizophrenia with suicidal ideation. The drug is started at a low dose and gradually increased to a target dose of 300–450 mg/day. It is well known to cause agranulocytosis and neutropenia. Several cases of fatal sepsis have been reported in neutropenic patients and emphasis is placed on monitoring for agranulocytosis; however, clozapine also causes intestinal hypomotility and constipation, which if unrecognized can lead to intestinal obstruction, bowel necrosis, and intra-abdominal sepsis. Reduced behavioral pain reactivity in schizophrenics may alter the ability to express pain, potentially leading to a delay in the presentation for medical attention. We report a case of fatal intra-abdominal sepsis secondary to an unrecognized case of clozapine-related constipation.

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A fatal case of ischemic colitis during clozapine administration

Cited by 15 publications

References 5 publications

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Treatment of clozapine-associated weight gain: a systematic review

Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis – a case report

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A fatal case of ischemic colitis during clozapine administration

Cited by 15 publications

References 5 publications

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

Treatment of clozapine-associated weight gain: a systematic review

Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis &ndash; a case report

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Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis – a case report