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7 - Managing Constipation

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer  and
Stephen M. Stahl
Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, San Diego
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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 Handbook
Stahl's Handbooks
 , pp. 140 - 157
Publisher: Cambridge University Press
Print publication year: 2019

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