The article discusses a case of clozapine-induced refractory colonic pseudo-obstruction in a patient with treatment-resistant schizophrenia (TRS), emphasizing the need for monitoring and potentially early surgical intervention due to severe gastrointestinal effects. Here's a summary of the key points:
- **Background**: Clozapine, an atypical antipsychotic used for TRS, has well-known hematological adverse effects requiring close monitoring. However, its gastrointestinal side effects, particularly on bowel motility, are less recognized but can lead to severe conditions like colonic pseudo-obstruction, necessitating total colectomy.
- **Case Presentation**: A 60-year-old female with TRS developed refractory colonic pseudo-obstruction, chronic ischemic colitis, and eventually required emergency total colectomy and end ileostomy after presenting with symptoms of fevers, hypotension, tachycardia, vomiting, overflow diarrhea, and reduced consciousness.
- **Treatment and Outcome**: Despite aggressive non-operative management including oral aperients, phosphate fleet enemas, neostigmine infusions, and optimization of electrolytes, the patient's condition did not improve. Surgical intervention was ultimately necessary due to the severe and life-threatening nature of her gastrointestinal complications.
- **Discussion**: Clozapine's anticholinergic effects lead to decreased gastrointestinal motility, increasing the risk for conditions like colonic pseudo-obstruction and stercoral colitis. The case underscores the importance of monitoring clozapine's gastrointestinal side effects and considering early surgical options in refractory cases.
- **Conclusions**: Clinicians should closely monitor patients on clozapine for gastrointestinal hypomotility and other adverse effects. Preventative measures and early intervention are crucial to avoid severe outcomes like the need for total colectomy.
This case highlights the critical need for awareness and proactive management of the gastrointestinal side effects of clozapine to prevent potentially life-threatening conditions.
Siriwardena D et al. Cureus. 2024