Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland

Ingimarsson, Oddur; MacCabe, James H.; Sigurðsson, Engilbert

doi:10.1080/08039488.2018.1517189

Cited by 16 publications

(5 citation statements)

References 22 publications

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“…These include several uncommon but serious problems, such as neutropenia/agranulocytosis, myocarditis/cardiomyopathy, 4 , 5 pneumonia 6 and seizures. In addition, there are side effects that may become serious if overlooked, such as constipation, 7 – 9 weight gain and metabolic syndrome, 10 , 11 and others that are potentially discomfiting or distressing such as hypersalivation, sedation, orthostatic hypotension and nocturnal enuresis. 12 Clozapine is associated with high rates of cardio-metabolic risk factors which may be both under-detected and under-treated.…”

Section: Introductionmentioning

confidence: 99%

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Barnes

MacCabe

Kane

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. Conclusion: The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.

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Section: Introductionmentioning

confidence: 99%

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

Barnes

MacCabe

Kane

et al. 2020

Therapeutic Advances in Psychopharmacology

Self Cite

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“…The impact of CIGH has not been recognised until recently (Ingimarsson et al, 2018). Due to the mechanism of CIGH, the reviewed literature indicates that prophylactic aperient treatment is recommended.…”

Section: Resultsmentioning

confidence: 99%

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2022

Aust N Z J Psychiatry

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Background: This talk focuses on classic psychedelic drugs, compounds such as psilocybin and LSD that have direct agonist properties at the serotonin 2A receptor.Objectives: It will endeavor to address the pharmacological action of classic psychedelics, broader understanding of serotonin 2A receptor functioning, the acute brain effects of psychedelics -as determined by functional brain imaging, the therapeutic potential and approach of psychedelic therapy, and its potential therapeutic action.Methods: Data is presented from functional neuroimaging experiments with classic psychedelics as well as from clinical trials of psilocybin therapy for depression. Neuroimaging methods include functional magnetic resonance imaging (fMRI).Findings: fMRI findings of decreased network integrity and segregation under psychedelics is presented, as is new data of decreased whole-brain modularity after psilocybin therapy for depression. Conclusions:The talk will provide a multi-level overview of the brain and putative therapeutic action of psychedelic therapy -as pertains to classic psychedelic drugs such as psilocybin. Implications for best practice in psychedelic therapy will be discussed.

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“…A study focusing on ileus alone (Nielsen 2012) found an increased risk with increasing age (OR = 1.03, 95% CI 1.01–1.04), female gender (OR = 1.60, 95% CI 1.10–1.23) and duration of clozapine treatment (OR = 1.99, 95% CI 1.21–3.29). The onset of ileus occurred on average more than 3 years after the prescription of the offending drug, and a recent Icelandic study (Ingimarsson 2018) found a mean time to ileus of 13.7 years. However, a review of the literature (West 2017) lists risk factors for CIGH as older age, male gender, the first 4 months of treatment, co-prescription of constipating agents, higher doses and previous CIGH.…”

Section: Risk Factors For Constipation In Schizophreniamentioning

confidence: 96%

“…Constipation caused by clozapine-induced gastrointestinal hypomotility (CIGH) is much more common than clozapine-induced blood dyscrasias and has a higher mortality rate (Cohen 2012; Every-Palmer 2016; Ingimarsson 2018). When prescribing clozapine, strict criteria must be followed to assertively monitor, detect and treat related blood dyscrasias (clozapine SmPC: Box 1).…”

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confidence: 99%

Clozapine: why wait to start a laxative?

Attard

Iles

Attard³

et al. 2019

BJPsych advances

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SUMMARYClozapine, the antipsychotic of choice for treatment-resistant schizophrenia, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death. CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Although strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.LEARNING OBJECTIVES:After reading this article you will be able to: •understand the mechanism of gastrointestinal hypomotility in those taking clozapine•improve the monitoring of clozapine-induced constipation•understand prophylactic laxative treatment and the use of less commonly prescribed laxatives in patients who experience clozapine-induced constipation.

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Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland

Cited by 16 publications

References 22 publications

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services

RANZCP Abstracts

Clozapine: why wait to start a laxative?

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