Antipsychotics-induced ischaemic colitis and gastrointestinal necrosis: a review of the French pharmacovigilance database.
OBJECTIVE
First- and second-generation antipsychotics commonly cause mild gastrointestinal hypomotility. Intestinal necrosis may be a consequence of such gastrointestinal perturbations.


METHODS
We reviewed all the observations of ischaemic colitis and gastrointestinal necrosis notified to the French Pharmacovigilance database (FPD) between 1997 and the end of 2006.


RESULTS
Thirty-eight cases of ischaemic colitis and gastrointestinal necrosis associated with antipsychotics were analysed. The average age of the patients was 42.7 +/- 14.7 years (15-77 years). The digestive complication was an intestinal necrosis in 27 cases, an ischaemic colitis in 10 cases (with perforation in three cases), and one perforation. Surgical procedure (partial or total resection of the colon and/or small intestine) was performed in 24 patients. Six patients died despite surgery. Among the whole population, the outcome was fatal in 14 patients, 13 patients recovered with sequelae, six patients fully recovered, and the outcome remained unknown in five cases.In 55.2% of the cases, the patients were treated with more than one antipsychotic medication. The most frequently involved antipsychotics were: clozapine, levomepromazine, cyamemazine, haloperidol. Associated antimuscarinic drugs (excluding antipsychotics) were found in 68.4% of patients.


CONCLUSIONS
Intestinal necrosis associated with antipsychotics is very rare; however mortality is high, with a rapid worsening of patients towards septic shock in spite of mild clinical symptoms. It is therefore essential to monitor the patients receiving antipsychotics especially when they are prescribed concomitant medications. The occurrence of non-specific clinical symptoms such as abdominal pain associated with vomiting and/or diarrhea should draw attention.
Peyrière
Hélène
H
Medical Pharmacology and Toxicology Department, Lapeyronie Hospital, CHU Montpellier, France. h-peyriere@chu-montpellier.fr
Roux
Clarisse
C
Ferard
Claire
C
Deleau
Nathalie
N
Kreft-Jais
Carmen
C
Hillaire-Buys
D
D
Boulenger
Jean-Philippe
JP
Blayac
Jean-Pierre
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003092:Colitis / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D003106:Colon / Q000098:blood supply* / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D019992:Databases as Topic; D005260:Female; D005602:France / Q000453:epidemiology; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D007511:Ischemia / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000009:adverse effects; D009336:Necrosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents; D018727:Muscarinic Antagonists