• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Blogs » The Carlat Psychiatry Blog » How To Prevent a Lethal Clozapine Side Effect

The Carlat Psychiatry Blog
The Carlat Psychiatry Blog RSS FeedRSS

How To Prevent a Lethal Clozapine Side Effect

August 16, 2020
Gastric hypomotility is a common clozapine side effect that can develop into the potentially lethal condition of paralytic ileus. Dr. Aiken’s covered these risks in The Carlat Psychiatry Report. Here’s what you need to know.

Dangers of Paralytic Ileus:

  • Hypomotility is very common. Clozapine is the worst offender out of any other antipsychotics. 50% - 80% of clozapine patients experience hypomotility.

  • High fatality rate. Approximately, 1 in 1000 clozapine-treated patients die from bowel complications. This is 3-6 times higher than the death rate of clozapine-induced neutropenia. 

  • Anticholinergics increase the risk. Elderly patients on clozapine and anticholinergics are  6 times more likely to develop intestinal ileus. The FDA advises minimizing the use of other constipating medications as well as anticholinergics, including Cogentin and Benadryl, with clozapine.

  • Fiber supplements won’t help. When constipation is caused by hypomotility, fiber supplements and bulk-forming laxatives should be avoided. These treatments form a bulk that can block the intestines. 


Warning Patients: 

1. Educate patients about paralytic ileus and the symptoms of hypomotility prior to starting clozapine.

2. More aggressive treatment is needed if these constipation symptoms emerge:

  • Less than 3 bowel movements a week

  • Hard or dry stools

  • Difficulty passing gas


3. An urgent care evaluation is necessary when the previous symptoms are coupled with the more serious ones:

  • Moderate to severe abdominal pain lasting > 1 hour

  • Nausea, vomiting

  • Abdominal bloating or swelling

  • Bloody diarrhea


The Porirua Protocol:

1. Prevention. Start preventative treatment of docusate 100 mg qhs with senna 17.2 mg qhs along with a patient’s first clozapine prescription.

2. First Intervention. Increase preventative regimen to docusate 100 mg bid with senna 17.2 mg bid if the patient goes 48 hours without a bowel movement.

3. Second Intervention. After 4 days without a bowel movement, advise the patient to be evaluated by a primary care or urgent care provider to determine if enemas or disimpaction are needed. If disimpaction is required, then stop the senna and docusate treatment. If it is not required, then add MiraLAX 17 g bid.

4. Specialist Care. If constipation continues after these steps, then a primary care provider or gastroenterologist should take over the treatment.

To read the full article, subscribe to The Carlat Psychiatry Report here.
Carlat Total Access Subscriptions: Get access to every article on the website.

Complete access to every article you search on the website.

Shop for Total Access
Free Psychiatry Updates
The latest unbiased psychiatric information sent to your inbox.
Specify Your Interests
Featured Book
  • HospPsychiatry_Spiral_Binding_Sm.png

    Hospital Psychiatry Fact Book, First Edition (2025) - Spiral Bound

    This comprehensive guide is designed to be a valuable resource for professionals working in...
    READ MORE
Featured Video
  • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
    General Psychiatry

    KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

    Read More
Featured Podcast
  • shutterstock_2622607431.jpg
    General Psychiatry

    Should You Test MTHFR?

    MTHFR is a...
    Listen now
Recommended
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report
  • The Carlat Psychotherapy Report

Contact

carlat@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.