clozapine and Fecal-Impaction

Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastrointestinal tract unrelated to constipation. We describe a case of acute necrosis of the upper gastrointestinal tract and small bowel to due to clozapine and quetiapine.. A 66-year-old white man with a past medical history of schizophrenia, maintained on clozapine and quetiapine, presented with hypoxic respiratory failure caused by aspiration of feculent emesis due to impacted stool throughout his colon. His constipation resolved with discontinuation of clozapine and quetiapine, and his clinical condition improved. These medicines were restarted after 2 weeks, resulting in acute gastrointestinal necrosis from the mid esophagus through his entire small bowel. He died due to septic shock with Gram-negative rod bacteremia.. Clozapine may cause acute gastrointestinal necrosis.

Topics: Aged; Antipsychotic Agents; Clozapine; Constipation; Endoscopy, Digestive System; Esophagus; Fatal Outcome; Fecal Impaction; Gastrointestinal Diseases; Gram-Negative Bacterial Infections; Humans; Intestine, Small; Male; Necrosis; Respiratory Aspiration; Respiratory Insufficiency; Schizophrenia; Shock, Septic; Stomach; Vomiting

In Clozapine users constipation is among the reported side effects including agranulocytosis and myocarditis with prevalence rates ranging from 14% to 60%. In extreme cases this may lead to bowel obstruction and paralytic ileus which, if not detected and treated early, may lead to mortality up to 30%. We report the first case of hepatic outflow block secondary to compression of the liver by a distended colon upstream an impacted fecaloma in a 47-year old schizophrenic man treated by clozapine. Emergency sub-total colectomy was performed for pan-colonic ischemia. Surgery relieved the liver outflow block and was followed by uneventful outcome. Patients receiving clozapine should undergo routine laxatives and monitoring in order to limit the risk of clozapine-related ileus and bowel ischemia.

Topics: Antipsychotic Agents; Budd-Chiari Syndrome; Clozapine; Fecal Impaction; Humans; Male; Middle Aged; Schizophrenia

Clozapine is often the drug of choice within patients suffering from treatment-resistant paranoid schizophrenia. It has a complex side effects profile which includes potentially fatal agranulocytosis. Clozapine has also become increasingly associated with a range of other side effects including constipation and pneumonia. We report on a case of clozapine-induced severe constipation leading to a silent presentation of pneumonia with a subsequent respiratory arrest. To our knowledge, this is the first case report of pneumonia secondary to severe constipation occurring in the absence of respiratory aspiration of feculent vomitus. We suggest a new pathological mechanism by way of severe constipation leading to diaphragmatic dysfunction and subsequent clozapine-induced pneumonia. In addition, implications for clinical practice are outlined.

Topics: Adult; Antipsychotic Agents; Clozapine; Constipation; Fecal Impaction; Humans; Male; Pneumonia; Respiratory Insufficiency; Schizophrenia, Paranoid; Sigmoidoscopy

Antipsychotic are the cornerstone in the treatment of schizophrenia. They also have a number of side-effects. Constipation is thought to be common, and a potential serious side-effect, which has received little attention in recent literature.. We performed a retrospective study in consecutively admitted patients, between 2007 and 2009 and treated with antipsychotic medication, linking different electronic patient data to evaluate the prevalence and severity of constipation in patients with schizophrenia under routine treatment conditions.. Over a period of 22 months 36.3% of patients (99) received at least once a pharmacological treatment for constipation. On average medication for constipation was prescribed for 273 days. Severe cases (N = 50), non-responsive to initial treatment, got a plain x-ray of the abdomen. In 68.4% fecal impaction was found.. A high prevalence of constipation, often severe and needing medical interventions, was confirmed during the study period. Early detection, monitoring over treatment and early intervention of constipation could prevent serious consequences such as ileus.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Aripiprazole; Clozapine; Constipation; Enema; Fecal Impaction; Female; Gastrointestinal Agents; Humans; Lactulose; Male; Middle Aged; Piperazines; Polyethylene Glycols; Prevalence; Quinolones; Retrospective Studies; Risperidone; Schizophrenia; Severity of Illness Index; Young Adult

Topics: Antipsychotic Agents; Clozapine; Colostomy; Compartment Syndromes; Fecal Impaction; Humans; Male; Middle Aged

The aim of this paper was to describe the association of clozapine with life-threatening constipation.. Case report.. A 53-year-old man presented to the emergency department with severe abdominal pain and bilious vomiting after being on clozapine for over a year for schizoaffective disorder. Surgery revealed severe faecal impaction in the large and small bowel. Clozapine was ceased. There were significant difficulties in the subsequent psychiatric management. Clozapine was gradually reintroduced with concurrent laxative administration, which resulted in another episode of severe constipation with faecal impaction.. Clozapine can be associated with potentially life-threatening constipation. Psychiatrists, especially consultation liaison psychiatrists, physicians, surgeons and radiologists, should be aware of the seriousness of clozapine-induced constipation and its potentially fatal complications.

Topics: Antipsychotic Agents; Clozapine; Constipation; Drug Therapy, Combination; Fecal Impaction; Humans; Laxatives; Male; Middle Aged

Topics: Adult; Antipsychotic Agents; Clozapine; Colon; Colonic Diseases; Drug Therapy, Combination; Fatal Outcome; Fecal Impaction; Female; Humans; Intestinal Obstruction; Lung; Male; Middle Aged; Rectal Diseases; Rectum; Respiratory Aspiration; Schizophrenia

Aim of this article is to describe the first italian case reported in literature of a clozapine-induced intestinal occlusion with previous severe constipation in a 45-year-old male patient who had been treated with daily clozapine for 5 months because of treatment-resistant residual schizophrenia. When conservative treatment (intravenous fluids, fleet enema and rectal washout) was used and clozapine therapy was decreased, gastrointestinal symptoms rapidly improved and the patient had regular bowel motions within a week. Preventive measures (high-fiber diet, adequate fluid intake, stool softeners and exercise) was also used to ensure that clozapine therapy could be safely continued. Although constipation is a common and usually benign side effect of treatment with clozapine, this case-report highlights the consequences of undertreated and unrecognized marked constipation progressing to severe bowel obstruction (a complication which deserves more attention because it can lead to hospitalization and might be potentially fatal).

Topics: Antipsychotic Agents; Clozapine; Constipation; Fecal Impaction; Humans; Male; Middle Aged; Schizophrenia; Time Factors

There have been previous reported deaths due to clozapine-induced constipation. In all these cases patients have experienced prior abdominal symptoms over a period of weeks or months.. We report the sudden death due to constipation of a healthy young male patient on clozapine without any known history of prior abdominal symptoms.. Psychiatrists need to be alert to the medical emergencies which can occur in the context of clozapine treatment and also need to make other clinicians who may have contact with their patients aware of these.

Topics: Adult; Antipsychotic Agents; Clozapine; Colon; Fatal Outcome; Fecal Impaction; Humans; Ischemia; Male; Schizophrenia; Time Factors

Topics: Antipsychotic Agents; Clozapine; Constipation; Death, Sudden; Drug Therapy, Combination; Fecal Impaction; Humans; Male; Middle Aged; Pneumonia, Aspiration; Schizophrenia; Schizophrenic Psychology