clozapine and Deglutition-Disorders

This is a comprehensive review of antipsychotic (AP)-induced dysphagia and its complications: choking and pneumonia. Areas covered: Four PubMed searches were completed in 2018. The limited literature includes: 1) 45 case reports of AP-induced dysphagia with pharmacological mechanisms, 2) a systematic review of APs as a risk factor for dysphagia, 3) reviews suggesting adult patients with intellectual disability (ID) and dementia are prone to dysphagia (APs are a risk factor among multiple others), 4) studies of the increased risk of choking in patients with mental illness (APs are a contributing factor), 5) naturalistic pneumonia studies suggesting that pneumonia may contribute to AP-increased death in dementia, and 6) naturalistic studies suggesting that pneumonia may be a major cause of morbidity and mortality in clozapine patients. Expert commentary: The 2005 Food and Drug Administration requirement that package inserts warn of AP-induced dysphagia jumpstarted this area, but current studies are limited by: 1) its naturalistic nature, 2) the lack of dysphagia studies of patients with IDs and dementia on APs, and 3) the assumed indirect association between dysphagia with choking and pneumonia. Future clozapine studies on pneumonia, if they lead to a package insert warning, may have high potential to save lives.

Topics: Adult; Airway Obstruction; Antipsychotic Agents; Clozapine; Deglutition Disorders; Dementia; Drug Labeling; Humans; Intellectual Disability; Mental Disorders; Pneumonia; Risk Factors

Dysphagia has been reported as an adverse event for patients receiving rivastigmine for Alzheimer's disease (AD) treatment.. The purpose of this study was to determine the association between dysphagia and the usage of rivastigmine by using the pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS).. The risk of dysphagia in patients who took rivastigmine was compared with those of patients who took other medications. In addition, this study sought to determine if the dysphagia risk was influenced by sex, age, dosage, and medication routes of administration.. When compared to patients prescribed donepezil, galantamine, or memantine, individuals prescribed rivastigmine were almost twice as likely to report dysphagia as an adverse event. The dysphagia risk in individuals prescribed rivastigmine is comparable to individuals prescribed penicillamine but significantly higher than clozapine, drugs of which have been previously shown to be associated with elevated dysphagia likelihood. Individuals older than 80 were 122% more likely to report having dysphagia after being prescribed rivastigmine than patients that were 50-70 years of age. Oral administration of rivastigmine was associated with approximately 2 times greater likelihood of reporting dysphagia relative to users of the transdermal patch. In addition, dysphagia showed higher association with pneumonia than other commonly reported adverse events.. Patients prescribed rivastigmine were at greater risk of reporting dysphagia as an adverse event than patients prescribed many other medicines. This increase in dysphagia occurrence may be attributed to the dual inhibition of both acetylcholinesterase and butyrylcholinesterase.

Topics: Acetylcholinesterase; Alzheimer Disease; Butyrylcholinesterase; Cholinesterase Inhibitors; Clozapine; Deglutition Disorders; Donepezil; Galantamine; Humans; Memantine; Penicillamine; Risk Management; Rivastigmine; United States; United States Food and Drug Administration

Topics: Antipsychotic Agents; Clozapine; Databases, Factual; Deglutition Disorders; Drug-Related Side Effects and Adverse Reactions; Humans; Pharmacovigilance; Pneumonia; World Health Organization

Dysphagia is listed as a 'rare' side effect following clozapine treatment. In this case report, we describe how significant clozapine-induced dysphagia has led to significant reduction of nutritional intake with subsequent substantial weight loss. An 18-year-old single man with an established diagnosis of treatment-resistant paranoid schizophrenia recovered well on a therapeutic dose of clozapine. However, he was noted to lose weight significantly (up to 20% of his original weight) as the dose was uptitrated. This was brought about by development of dysphagia, likely to be due to clozapine. Addition of nutritional supplementary liquids and initiation of a modified behavioural dietary/swallowing programme, while repeatedly mastering the Mendelsohn manoeuvre technique, alleviated the swallowing difficulties and restored his weight.

Topics: Adolescent; Antipsychotic Agents; Clozapine; Deglutition Disorders; Diagnosis, Differential; Humans; Male; Schizophrenia, Paranoid; Treatment Outcome; Weight Loss

(1) Sialorrhoea is the production of saliva that patients perceive as excessive; (2) Saliva accumulation is either due to a reduction in swallowing frequency or to an increase in saliva production; (3) Patients who drool may be ostracized, and there is also an increased risk of aspiration pneumonia; (4) Sialorrhoea can be caused by buccal, gastrointestinal or neurological disorders, or by drugs; (5) Sedatives such as benzodiazepines, neuroleptics, cholinesterase inhibitors and pilocarpine carry a dose-dependent risk of sialorrhoea; (6) In practice, the role of a drug should be borne in mind when a patient presents with sialorrhoea or excessive saliva accumulation. The parents of children treated with sedative drugs should be informed of this risk.

Topics: Antipsychotic Agents; Benzodiazepines; Cholinesterase Inhibitors; Clozapine; Deglutition Disorders; Donepezil; Galantamine; Humans; Hypnotics and Sedatives; Indans; Phenylcarbamates; Pilocarpine; Piperidines; Quality of Life; Risperidone; Rivastigmine; Sialorrhea

Topics: Adult; Clozapine; Deglutition Disorders; Dose-Response Relationship, Drug; Drug Therapy, Combination; Esophageal Motility Disorders; Humans; Male; Psychotic Disorders; Sialorrhea

Topics: Adult; Airway Obstruction; Circadian Rhythm; Clozapine; Deglutition Disorders; Humans; Male; Psychotic Disorders; Sialorrhea; Sleep Wake Disorders