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