Clozapine-Related Functional Bowel Obstruction: A Rare Adverse Effect Unmasking Quetiapine and Benztropine Interaction Raising Need for Bowel Surveillance

Apoorv Tiwari; Swathi Kambhatla; Nathan George; Prathyusha Anumolu; Nikhale Malik; Sujata Kambhatla

doi:10.14309/crj.0000000000001351

Clozapine-Related Functional Bowel Obstruction: A Rare Adverse Effect Unmasking Quetiapine and Benztropine Interaction Raising Need for Bowel Surveillance

ACG Case Rep J. 2024 May 17;11(5):e01351. doi: 10.14309/crj.0000000000001351. eCollection 2024 May.

Authors

Apoorv Tiwari¹, Swathi Kambhatla², Nathan George³, Prathyusha Anumolu¹, Nikhale Malik¹, Sujata Kambhatla¹

Affiliations

¹ Department of Internal Medicine, Michigan State University, Garden City Hospital, Garden City, MI.
² Michigan State University, MI.
³ Garden City Hospital, Garden City, MI.

Abstract

Randomized controlled trials demonstrate a significant decline in hospital admissions and length of stay following the initiation of clozapine in individuals with bipolar disorder and schizophrenia, along with an increase in quality-adjusted life years. The morbidity and mortality associated with clozapine-induced gastrointestinal hypomotility (CIGH) is greater than agranulocytosis. Despite this, we only have clozapine risk evaluation and mitigation strategies by the US Food and Drug Administration for white cell count monitoring, but none exists for CIGH. Our case highlights CIGH due to multiple factors and recommendations to prevent it and enhance clozapine compliance by conducting a thorough literature review.

Keywords: CIGH; Clozapine; bowel surveillance; ileus.

Publication types

Case Reports