Reporting of clozapine-induced gastrointestinal hypomotility and factors associated with fatal outcomes in Canada: A pharmacovigilance database study

Cecilia L Liu; Abdullah Al Maruf; Chad A Bousman

doi:10.1016/j.psychres.2020.113048

Reporting of clozapine-induced gastrointestinal hypomotility and factors associated with fatal outcomes in Canada: A pharmacovigilance database study

Psychiatry Res. 2020 Aug:290:113048. doi: 10.1016/j.psychres.2020.113048. Epub 2020 May 16.

Authors

Cecilia L Liu¹, Abdullah Al Maruf², Chad A Bousman³

Affiliations

¹ Alberta Innovates Heritage Youth Researcher Summer Program, University of Calgary, Calgary, AB, Canada.
² Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada.
³ Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada; Department of Medical Genetics, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. Electronic address: chad.bousman@ucalagary.ca.

PMID: 32474068
DOI: 10.1016/j.psychres.2020.113048

Abstract

Clozapine-induced gastrointestinal hypomotility (CIGH) is poorly understood and potentially life-threatening. Herein, we present trends of CIGH annual reporting and explore factors associated with a fatal outcome using 25-years of pharmacovigilance data in Canada. Since 1993, the number of CIGH reports increased 22-fold but the proportion of fatal reports remained relatively stable. Fatal reports of CIGH were associated with older age but not sex, clozapine dose, or clozapine duration. Concomitant use of medications used to treat CIGH (lactulose, docusate sodium) and its associated pain/discomfort (acetaminophen, lorazepam) were more commonly reported in fatal cases. Confirmatory and prospective studies of CIGH are warranted.

Keywords: Canada; Clozapine; Gastrointestinal Hypomotility.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Antipsychotic Agents / adverse effects*
Antipsychotic Agents / therapeutic use
Canada / epidemiology
Clozapine / adverse effects*
Clozapine / therapeutic use
Databases, Factual / trends
Female
Gastrointestinal Diseases / chemically induced*
Gastrointestinal Diseases / diagnosis
Gastrointestinal Diseases / mortality*
Gastrointestinal Motility / drug effects*
Gastrointestinal Motility / physiology
Humans
Male
Middle Aged
Pharmacovigilance*
Prospective Studies

Substances

Antipsychotic Agents
Clozapine