Clozapine-induced gastrointestinal hypomotility (CIGH) affects some 75% of patients treated with clozapine.

To document the incidence of potentially harmful CIGH in the UK.

We studied spontaneous UK pharmacovigilance reports recorded as clozapine-related gastrointestinal adverse drug reactions, 1992–2017.

There were 527 patients reported with potentially harmful CIGH; 33% (n = 172) died. Deaths averaged 1 per year 1992–1999, 5 per year 2000–2009 and 15 per year 2010–2017. Those who died were older (median 52 years v. 49 years) and had been prescribed clozapine for longer than those who recovered (median 11.3 years v. 4.8 years), but there was no difference in prescribed dose. Within the first 4 years of clozapine treatment, there were 169 reports of CIGH, of which 3% (n = 5) were fatal. At 10–14 years there were 63 reports of CIGH, of which 25% (n = 16) were fatal. Among the deaths, males were younger (median 51, range 22–89 v. median 57, range 24–89 years) with higher clozapine doses (median 450, range 100–900 v. median 300, range 12.5–800 mg/d) than females. In non-fatal CIGH, surgery was the most frequent outcome (n = 92). The procedures included appendectomy, ileostomy, total/partial colectomy, colostomy/stoma and proctosigmoidectomy. Clozapine dosage was reduced in 6 patients, stopped and restarted in 23, ‘continued’ in 6 and discontinued permanently in at least 76 patients.

The risk of serious morbidity/mortality from CIGH is substantial. The need to actively monitor bowel function and give laxatives to patients treated with clozapine is clear.

约 75% 接受氯氮平治疗的患者会受到氯氮平诱发的胃肠动力低下 (CIGH) 的影响。

记录英国潜在有害 CIGH 的发生率。

我们研究了 1992 年至 2017 年记录为氯氮平相关胃肠道药物不良反应的英国自发药物警戒报告。

据报道，有 527 名患者患有潜在有害的 CIGH； 33% ( n = 172) 死亡。 1992年至1999年平均每年死亡1人，2000年至2009年每年平均死亡5人，2010年至2017年每年平均死亡15人。死亡者比康复者年龄更大（中位 52 岁vs 49 岁），服用氯氮平的时间也更长（中位 11.3 岁vs 4.8 岁），但处方剂量没有差异。在氯氮平治疗的前 4 年里，有 169 例 CIGH 报告，其中 3%（ n = 5）致命。在 10-14 岁时，有 63 例 CIGH 报告，其中 25% ( n = 16) 致命。在死亡病例中，男性年龄较小（中位数 51 岁，范围 22-89 岁vs.中位数 57 岁，范围 24-89 岁），氯氮平剂量较高（中位数 450 岁，范围 100-900 岁vs.中位数 300，范围 12.5-800 mg/d） ）比女性。在非致命性 CIGH 中，手术是最常见的结果 ( n = 92)。手术包括阑尾切除术、回肠造口术、全/部分结肠切除术、结肠造口/造口和直肠乙状结肠切除术。 6 名患者减少了氯氮平剂量，23 名患者停止并重新开始服用氯氮平，6 名患者“继续”服用，至少 76 名患者永久停用。

CIGH 导致严重发病/死亡的风险很大。显然，需要积极监测肠道功能并给接受氯氮平治疗的患者服用泻药。