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Fatalities Associated With Clozapine-Related Constipation and Bowel Obstruction: A Literature Review and Two Case Reports

Received January 28, 2008; revised April 7, 2008; accepted April 8, 2008. From the Institute of Community and Family Psychiatry, Montreal, Quebec; and the Division of Gastroenterology, Dept. of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Send correspondence and reprint requests to Katharine R. Hibbard, M.D., 4333 Chemin de la Cote Ste-Catherine, Montreal, Quebec H3T 1E4. e-mail: katharine.hibbard{at}mail.mcgill.ca
© 2009 The Academy of Psychosomatic Medicine

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. METHOD: 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. DISCUSSION: The discussion outlines potential mechanisms and management of clozapine-related constipation.

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