Fatalities associated with clozapine-related constipation and bowel obstruction: a literature review and two case reports.
BACKGROUND
Constipation is an exceedingly common side effect of treatment with clozapine. In rare cases, this side effect has resulted in fatal complications.


OBJECTIVE
The authors review the literature on fatal complications of clozapine-related constipation and bowel obstruction.


METHODS
The authors provide two new case reports of patients who died of similar causes.


RESULTS
There were seven reports of deaths from clozapine-related bowel obstruction in the literature, with the most common mechanisms of death being severe impaction leading either to feculent vomiting or bowel necrosis.


CONCLUSIONS
The discussion outlines potential mechanisms and management of clozapine-related constipation.
Hibbard
Katharine R
KR
correspondence and M.D., 4333 Chemin de la Cote Ste-Catherine, Montreal, Quebec H3T 1E4. katharine.hibbard@mail.mcgill.ca
Propst
Arthur
A
Frank
Daniel E
DE
Wyse
Jonathan
J
D000927:Anticonvulsants / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003024:Clozapine / Q000008:administration & dosage / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced* / Q000401:mortality*; D004359:Drug Therapy, Combination; D005479:Flurazepam / Q000008:administration & dosage; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects; D005905:Glyburide / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007415:Intestinal Obstruction / Q000139:chemically induced* / Q000401:mortality*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D000077213:Lamotrigine; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D011352:Procyclidine / Q000008:administration & dosage; D012559:Schizophrenia / Q000188:drug therapy*; D013974:Thyroxine / Q000008:administration & dosage; D014227:Triazines / Q000008:administration & dosage
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D018757:GABA Modulators; D007004:Hypoglycemic Agents; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D014227:Triazines; D011352:Procyclidine; D005479:Flurazepam; D003024:Clozapine; C005419:oxybutynin; D013974:Thyroxine; D005905:Glyburide; D000077213:Lamotrigine