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Journal of Pharmacy Practice
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Successful Clozapine Rechallenge Following Surgical Repair of a Bowel Obstruction

Megan M. Dahmen, PharmD

University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, Northwest Missouri Psychiatric Rehabilitation Center, St Joseph, Missouri

Steven C. Stoner, PharmD, BCPP

University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, stoners{at}umkc.edu, Northwest Missouri Psychiatric Rehabilitation Center, St Joseph, Missouri

Rintu Khan, MD

Northwest Missouri Psychiatric Rehabilitation Center, St Joseph, Missouri

As a consequence of its significant anticholinergic properties, constipation is a commonly reported adverse event in patients treated with clozapine. This side effect is often self-limiting and can be managed with high-fiber diets, adequate hydration, and standard over-the-counter and prescription preparations. However, severe cases of constipation can become more serious and may lead to intestinal obstruction, intestinal perforation, fecal impaction, or paralytic ileus. In this particular case, we report on a 44-year-old woman who presented with a suspected clozapine-induced bowel obstruction. Following total abdominal colectomy with ileosigmoid anastomosis, the patient was rechallenged with clozapine and tolerated the titration to a therapeutic dose and maintenance therapy without further incident.

Key Words: clozapine • bowel obstruction • constipation • rechallenge • refractory psychosis • adverse events

This version was published on April 1, 2009

Journal of Pharmacy Practice, Vol. 22, No. 2, 196-199 (2009)
DOI: 10.1177/0897190008326577
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