clozapine and Respiratory-Insufficiency

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

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

We studied the development of metabolic disorders related to tissue hypoxia in 54 patients with acute severe asaleptin intoxication complicated by acute respiratory insfficiency of mixed genesis. We also estimated the role of a substrate antihypoxant cytoflavin in the correction of these disorders and clinical features of acute intoxication. Cyroflavin was shown to accelerate normalization of metabolic disorders which in turn improves clinical symptoms of severe forms of acute asaleptin intoxication.

Topics: Acute Disease; Adult; Antipsychotic Agents; Clozapine; Drug Combinations; Female; Flavin Mononucleotide; Humans; Hypoxia; Inosine Diphosphate; Male; Metabolic Diseases; Middle Aged; Niacinamide; Respiratory Insufficiency; Severity of Illness Index; Succinates; Young Adult

Idiosyncratic reactions are serious, unpredicted adverse effects of antiepileptic drugs which are in use in psychiatry as mood stabilizers. Severe idiosyncratic reactions can manifest as systemic symptoms or Dress syndrome clinically manifested with increased body temperature, peripheral lymphadenopathy and potential one or multiple organ failure. We present a 36 years old patient, who was hospitalized for the first time in our hospital after he attempted suicide by hanging. Patient was diagnosed as Bipolar affective disorder, current episode depressive with psychotic features and high suicidal risk. At the time of admission he was taking olanzapine and venlafaxine. Psychopharmacs were cross titrated to clozapine, valproic acid and lamotrigine. Two weeks later, patient's mood was stabilized but his somatic status worsened dramatically. He was forwarded to Clinic for Infective Diseases where he was diagnosed with severe sepsis. Dress syndrome, although initially suspected was not verified, but has to be taken into consideration in each patient prescribed with antiepileptic drugs.

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Clozapine; Diagnosis, Differential; Drug Therapy, Combination; Humans; Lamotrigine; Male; Pericarditis; Respiratory Insufficiency; Systemic Inflammatory Response Syndrome; Triazines; Valproic Acid

Previously published case reports have noted severe adverse reactions such as cardiac arrest, respiratory arrest, and sudden death when clozapine (CLZ) and benzodiazepines (BZDs) are used concomitantly. As CLZ and BZD are both used regularly to treat psychiatric illness, it is important to have additional information concerning this potential interaction. The objective of this study was to contribute to the evolving literature by evaluating the occurrence of sudden deaths and cardiac or respiratory events leading to death in patients treated concurrently with CLZ and BZD.. A retrospective chart review was conducted at a 240-bed New York State mental health facility. Most patients in this facility have been diagnosed with refractory schizophrenia, resulting in high rates of CLZ use. Electronic and hard copy records of the 490 patients who had been treated with CLZ in this facility at any time from 2001 to 2006 were selected, and the medication records of these patients were assessed for concomitant BZD use. Information on 152 patients who were treated with CLZ and a BZD concomitantly during this time period are included in this study. Data from the facility's mortality review committee were obtained to determine sudden deaths and cardiac or respiratory events leading to death in patients treated with CLZ and BZD concomitantly. Secondary parameters also recorded during the chart review included average duration of CLZ therapy, BZD therapy, and concomitant therapy; average doses of agents used; specific BZD used; number of patients treated with a specific BZD; psychiatric diagnosis; and use of other medications that depress the central nervous system.. No deaths occurred as a result of concomitant BZD and CLZ use in the sample examined in this study, suggesting that CLZ and BZD may be safely used concomitantly in many cases. Further study is needed to determine patient characteristics or predisposing factors that might put patients at higher risk of death from this interaction. Our findings are limited by the small sample size and suboptimal frequency of side effect measurements (e.g., measurements of blood pressure and heart rate, reports of hypotensive episodes). Confounding variables that might also play a role in interactions between CLZ and BZDs, but which were not measured in this study, include other types of respiratory compromise, cognitive dysfunction, and organ dysfunction. Precautionary measures that may be used when initiating concomitant CLZ and BZD therapy include slow titration of CLZ, blood pressure monitoring, and/or nightly pulse oximeter measurements.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Cross-Sectional Studies; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Heart Arrest; Humans; Male; Medical Records; Middle Aged; Respiratory Insufficiency; Retrospective Studies; Schizophrenia

Topics: Adult; Clozapine; Death, Sudden; Drug Interactions; Drug Therapy, Combination; Humans; Injections, Intravenous; Lorazepam; Male; Respiratory Insufficiency; Schizophrenia, Paranoid; Sleep Wake Disorders

Topics: Adult; Clozapine; Dibenzazepines; Drug Therapy, Combination; Female; Humans; Neuroleptic Malignant Syndrome; Puerperal Disorders; Referral and Consultation; Respiratory Insufficiency; Schizophrenia, Catatonic