Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
7 - Managing Constipation
Published online by Cambridge University Press: 19 October 2021
Book contents
- The Clozapine Handbook
- The Clozapine Handbook
- Copyright page
- Additional material
- Contents
- Foreword
- Introduction
- 1 The Efficacy Story: Treatment-Resistant Schizophrenia, Psychogenic Polydipsia, Treatment-Intolerant Schizophrenia, Suicidality, Violence, Mania and Parkinson’s Disease Psychosis
- 2 Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients
- 3 Initiating Clozapine
- 4 Discontinuing Clozapine and Management of Cholinergic Rebound
- 5 Binding Profile, Metabolism, Kinetics, Drug Interactions and Use of Plasma Levels
- 6 Understanding Hematologic Monitoring and Benign Ethnic Neutropenia
- 7 Managing Constipation
- 8 Managing Sedation, Orthostasis and Tachycardia
- 9 Managing Sialorrhea
- 10 Managing Seizure Risk and Stuttering
- 11 Managing Metabolic Adverse Effects
- 12 Fever, Myocarditis, Interstitial Nephritis, DRESS, Serositis and Cardiomyopathy
- 13 Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder
- 14 Eosinophilia, Leukocytosis, Thrombocytopenia, Thrombocytosis, Anemia, Hepatic Function Abnormalities
- 15 Special Topics: Child and Adolescent Patients, Elderly Patients, Patients With Intellectual Disability, Pregnancy and Risk for Major Congenital Malformation, Lactation, Overdose, Postmortem Redistribution
- Index
- References
Summary
Constipation is a common problem in western societies, but gastrointestinal hypomotility (GIH) assumes greater significance during clozapine therapy for several reasons: GIH is highly prevalent; GIH accounts for 36% of all medically related causes of treatment discontinuation; and in its most severe form, paralytic ileus, there is a fatality rate of 15.0–27.5%. Gastrointestinal illness accounted for 20% of all medically related hospital admissions for clozapine-treated patients at one major US medical center, of which 61% were for hypomotility-related problems. The magnitude of clozapine’s effect on motility is dramatic: the median colonic transit time (CTT) in one study was 23 hours among inpatients on nonclozapine antipsychotics, compared to 104 hours for those on clozapine. Moreover, 80% of the clozapine-treated patients had evidence of GIH, and transit times in all colonic segments were abnormal. Importantly, clozapine-associated GIH occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Only plasma clozapine level correlated with GIH severity as measured by transit time.
- Type
- Chapter
- Information
- The Clozapine HandbookStahl's Handbooks, pp. 140 - 157Publisher: Cambridge University PressPrint publication year: 2019
References
Pai, N. B. and Vella, S. C. (2012). Reason for clozapine cessation. Acta Psychiatrica Scandinavica, 125, 39–44.Google Scholar
Cohen, D. (2017). Clozapine and gastrointestinal hypomotility. CNS Drugs, 31, 1083–1091.CrossRefGoogle ScholarPubMed
Leung, J. G., Hasassri, M. E., Barreto, J. N., et al. (2017). Characterization of admission types in medically hospitalized patients prescribed clozapine. Psychosomatics, 58, 164–172.Google Scholar
Every-Palmer, S., Nowitz, M., Stanley, J., et al. (2016). Clozapine-treated patients have marked gastrointestinal hypomotility, the probable basis of life-threatening gastrointestinal complications: A cross sectional study. EBioMedicine, 5, 125–134.CrossRefGoogle ScholarPubMed
Nielsen, J. and Meyer, J. M. (2012). Risk factors for ileus in patients with schizophrenia. Schizophrenia Bulletin, 38, 592–598.Google Scholar
Solismaa, A., Kampman, O., Lyytikainen, L. P., et al. (2018). Genetic polymorphisms associated with constipation and anticholinergic symptoms in patients receiving clozapine. Journal of Clinical Psychopharmacology, 38, 193–199.CrossRefGoogle ScholarPubMed
Lacy, B. E., Mearin, F., Chang, L., et al. (2016). Bowel disorders. Gastroenterology, 150, 1393–1407.CrossRefGoogle Scholar
Lewis, S. J. and Heaton, K. W. (1997). Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology, 32, 920–924.CrossRefGoogle ScholarPubMed
Every-Palmer, S., Newton-Howes, G. and Clarke, M. J. (2017). Pharmacological treatment for antipsychotic-related constipation. Cochrane Database of Systematic Reviews, 1, Cd011128.Google Scholar
Wald, A. (2016). Constipation: Advances in diagnosis and treatment. JAMA, 315, 185–191.Google Scholar
Taylor, D., Paton, C. and Kapur, S. (2015). The Maudsley Prescribing Guidelines in Psychiatry, 12th Edition. Chichester: Wiley-Blackwell.Google Scholar
Every-Palmer, S., Ellis, P. M., Nowitz, M., et al. (2017). The Porirua Protocol in the treatment of clozapine-induced gastrointestinal hypomotility and constipation: A pre- and post-treatment study. CNS Drugs, 31, 75–85.CrossRefGoogle ScholarPubMed
Lacy, B. E. and Levy, L. C. (2008). Lubiprostone: A novel treatment for chronic constipation. Clinical Interventions in Aging, 3, 357–364.Google Scholar
Meyer, J. M. and Cummings, M. A. (2014). Lubiprostone for treatment-resistant constipation associated with clozapine use. Acta Psychiatrica Scandinavica, 130, 71–72.CrossRefGoogle ScholarPubMed
Love, B. L., Johnson, A. and Smith, L. S. (2014). Linaclotide: A novel agent for chronic constipation and irritable bowel syndrome. American Journal of Health-System Pharmacy, 71, 1081–1091.Google Scholar
Nee, J., Zakari, M., Sugarman, M. A., et al. (2018). Efficacy of treatments for opioid-induced constipation: A systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 16, 1569–1584.CrossRefGoogle ScholarPubMed
Thomas, N., Jain, N., Connally, F., et al. (2018). Prucalopride in clozapine-induced constipation. Australian & New Zealand Journal of Psychiatry, 52, 804.Google Scholar
Canadian Agency for Drugs and Technologies in Health. (2014). Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health.Google Scholar