Prophylactic Aperients in Clozapine Patients: A Review of the Literature

Abstract

Background: Clozapine use has been revolutionary in the management of treatment-resistant schizophrenia. A common but rarely recognised side effect is clozapineinduced gastric hypomobility (CIGH). CIGH is more common than blood dyscrasias with a mortality rate of up to 18%, if undiagnosed (Attard et al., 2019; Nakamura and Nagamine, 2021). As such, it is important to distinguish the role of prophylactic aperient prescribing with clozapine use. Objective(s): To review the literature to identify a role for the addition of prophylactic aperient prescribing within clozapine protocols. Method(s): Searches were performed on Medline, Embase, Web of Science and the Cochrane Library. Study selection, data extraction and quality assessment were conducted. Relevant articles were reviewed to explore the role of prophylactic aperient prescribing in clozapine patients. Finding(s): The impact of CIGH has not been recognised until recently (Ingimarsson et al., 2018). Due to the mechanism of CIGH, the reviewed literature indicates that prophylactic aperient treatment is recommended. Of the aperients, the first-line choice of sodium docusate or macrogol and senna is the preferred choice for CIGH (Oke et al., 2015; Palmer et al., 2008). Conclusion(s): CIGH is a significant adverse side effect of clozapine use. Current literature has identified a role of prophylactic aperient prescribing with strict bowel monitoring, which is not as rigorously followed in clinical practice in clozapine initiation, despite the higher mortality levels associated with the progression of CIGH (Attard et al., 2019). Adverse outcomes could be avoided with more rigorous bowel monitoring and the introduction of prophylactic aperients in clozapine patients.