Antipsychotics

Question 1

Describe the risk of gastrointestinal side effects with clozapine.

Answer 1

Severe gastrointestinal adverse reactions have occurred with the use of clozapine causing potential outcomes of hospitalisation, surgery and death.

Question 2

Describe the relationship between the patient’s subjective symptoms of constipation and gastrointestinal hypomotility associated with clozapine.

Answer 2

The subjective symptoms of constipation may not accurately reflect the degree of gastrointestinal hypomotility.

Question 3

What monitoring is required in relation to gastrointestinal hypomotility with clozapine?

Answer 3

Health professionals should carefully monitor any changes in the frequency or character of a patient’s bowel movements, as well as signs and symptoms of complications of hypomotility, such as:
• Nausea and/or vomiting
• Abdominal distension and/or pain
• Lack of urge and/or inability to defecate
• Constipation

Question 4

How should patients taking clozapine with evidence of constipation or gastrointestinal hypomotility be managed?

Answer 4

Patients with evidence of constipation or gastrointestinal hypomotility should be managed promptly to prevent severe complications.

Question 5

Describe the use of clozapine in patients with a current diagnosis or prior history of constipation?

Answer 5

Clozapine should be used with caution and under careful supervision in patients with a current diagnosis or prior history of constipation.

Question 6

Describe the concomitant use of clozapine and anticholinergic medicines.

Answer 6

Concomitant use of clozapine with anticholinergic medicines should be avoided where possible because of the increased risk of severe gastrointestinal side effects and/or anticholinergic toxicity.