Tomulescu Silviu, Uittenhove Kim, Boukakiou Reda
Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
Université de Genève, 24, Rue du Général-Dufour CH, 1211 Genève, Switzerland.
Case Rep Psychiatry. 2021 Nov 8;2021:9649334. doi: 10.1155/2021/9649334. eCollection 2021.
Clozapine is an effective antipsychotic for the treatment of resistant schizophrenia. However, clozapine can lead to serious side effects. One of the most common side effects is constipation and in rare cases ileus, which is associated with a considerable case fatality rate. Our patient exhibited repeated episodes of ileus while being treated with clozapine. We adapted the treatment of the patient in several ways to manage these severe side effects. First, we reduced clozapine dosage by opting for an augmentation strategy of clozapine through paliperidone. Then, we added linaclotide as a nonconventional laxative. We further adapted treatment after the occurrence of a volvulus prompting surgical intervention which revealed a malformation of the intestines' peritoneal attachment. A gastrostomy to facilitate the treatment of any further episode was performed and bethanechol was introduced alongside linaclotide. Follow-up revealed the efficacy of our strategy involving the use of linaclotide in managing the side effects of clozapine in this patient.
氯氮平是治疗难治性精神分裂症的一种有效抗精神病药物。然而，氯氮平可导致严重的副作用。最常见的副作用之一是便秘，在罕见情况下会出现肠梗阻，这与相当高的病死率相关。我们的患者在接受氯氮平治疗期间反复出现肠梗阻发作。我们通过多种方式调整对该患者的治疗以应对这些严重副作用。首先，我们通过选用帕利哌酮增强氯氮平的治疗策略来降低氯氮平剂量。然后，我们添加利那洛肽作为一种非常规泻药。在发生肠扭转促使进行手术干预后，我们进一步调整了治疗方案，手术显示肠道腹膜附着存在畸形。进行了胃造口术以方便处理任何进一步发作的情况，并在使用利那洛肽的同时引入了氨甲酰甲胆碱。随访结果显示我们使用利那洛肽来管理该患者氯氮平副作用的策略是有效的。
