Clozapine – constipation as an under-recognised life-threatening effect of clozapine

There have been a number of serious incidents in the last two years involving NTW community patients taking clozapine. One patient had his entire colon removed and now has a stoma. Another patient was admitted to hospital with severe abdominal pain and was diagnosed with a twisted bowel as a result of constipation. The patient did not survive the corrective surgery.

Learning Points:

  • Educate patients about the risk of constipation
  • Screen regularly asking the patient about change in bowel habits and change in appetite
  • Ensure adequate fluid intake
  • Ensure adequate dietary fibre intake
  • Increase mobility / exercise
  • Intervene actively when patients report constipation ensuring that and an effective laxative regimen is prescribed promptly
  • Stop other medicines that may be contributing to constipation
  • Reduce clozapine dose if possible
  • Request an abdominal examination if indicated
  • Refer urgently all patients who present with symptoms indicating a potentially life-threatening gastrointestinal complication – clozapine should be temporarily discontinued