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Clozapine-associated adverse drug reactions in 38,349 psychiatric inpatients: drug surveillance data from the AMSP project between 1993 and 2016.
J Neural Transm (Vienna)
September 2024
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany.
Article Synopsis
- Clozapine, a second-generation antipsychotic, shows better treatment outcomes for schizophrenia but comes with significant risks, as shown by a study on 38,349 inpatient patients from 1993-2016.
- The study found that 1.53% of patients experienced severe adverse drug reactions (ADRs), with older patients (≥65 years) at greater risk compared to younger ones (<65 years).
- Common severe ADRs included grand mal seizures, delirium, increased liver enzymes, and agranulocytosis, with five cases leading to death; the findings stress the need for careful monitoring and awareness of potential symptoms during clozapine treatment.
Clozapine is an effective antipsychotic with antidopaminergic, anticholinergic and antiserotonergic effects. Due to potential adverse events, agranulocytosis being the most feared, patients using clozapine need to be closely monitored. A lesser known but equally common and potential lethal adverse effect is clozapine-induced gastrointestinal hypomotility (CIGH), which can cause a paralytic ileus, gut mucosal ischemia or aspiration pneumonia.
View Article and Find Full Text PDFParadoxical refractory hypotension following adrenaline administration in a patient taking clozapine.
BMJ Case Rep
November 2021
Department of Acute Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
Clozapine is a potent antipsychotic commonly used for refractory schizophrenia. Adverse effects are well recognised including constipation, intestinal obstruction, agranulocytosis and cardiomyopathy. We present a case of paradoxical refractory hypotension following epinephrine administration in a patient taking clozapine.
View Article and Find Full Text PDFClozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals.
Br Med Bull
October 2020
Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Newtown, Wellington 6242, NZ.
Background: Clozapine remains the only medication licensed for treating refractory schizophrenia. However, it remains underutilized in part due to concerns regarding adverse events.
Sources Of Data: Published literature.
Constipation screening in people taking clozapine: A diagnostic accuracy study.
Schizophr Res
June 2020
Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
Objective: Clozapine is the favoured antipsychotic for treatment-refractory schizophrenia but its safe use requires careful adverse-effect management. Clozapine-induced gastrointestinal hypomotility (CIGH or 'slow-gut') is one of the most common and serious of clozapine's adverse effects. CIGH can lead to paralytic ileus, bowel obstruction, gastrointestinal ischaemia, toxic megacolon, and death.
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