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氯氮平相关的功能性肠梗阻:一种罕见的不良反应揭示了喹硫平和苯海索的相互作用,增加了肠道监测的必要性。

Clozapine-Related Functional Bowel Obstruction: A Rare Adverse Effect Unmasking Quetiapine and Benztropine Interaction Raising Need for Bowel Surveillance.

作者信息

Tiwari Apoorv, Kambhatla Swathi, George Nathan, Anumolu Prathyusha, Malik Nikhale, Kambhatla Sujata

机构信息

Department of Internal Medicine, Michigan State University, Garden City Hospital, Garden City, MI.

Michigan State University, MI.

出版信息

ACG Case Rep J. 2024 May 17;11(5):e01351. doi: 10.14309/crj.0000000000001351. eCollection 2024 May.

DOI:10.14309/crj.0000000000001351
PMID:38764552
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11101216/
Abstract

Randomized controlled trials demonstrate a significant decline in hospital admissions and length of stay following the initiation of clozapine in individuals with bipolar disorder and schizophrenia, along with an increase in quality-adjusted life years. The morbidity and mortality associated with clozapine-induced gastrointestinal hypomotility (CIGH) is greater than agranulocytosis. Despite this, we only have clozapine risk evaluation and mitigation strategies by the US Food and Drug Administration for white cell count monitoring, but none exists for CIGH. Our case highlights CIGH due to multiple factors and recommendations to prevent it and enhance clozapine compliance by conducting a thorough literature review.

摘要

随机对照试验表明,在双相情感障碍和精神分裂症患者中开始使用氯氮平后,住院人数和住院时间显著下降,同时质量调整生命年增加。与氯氮平引起的胃肠道动力不足(CIGH)相关的发病率和死亡率高于粒细胞缺乏症。尽管如此,美国食品药品监督管理局仅制定了氯氮平风险评估和缓解策略用于监测白细胞计数,而针对CIGH却没有相关策略。我们的病例突出了由多种因素导致的CIGH,并通过全面的文献综述提出了预防CIGH以及提高氯氮平依从性的建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/feb9/11101216/7aedc8facd2d/ac9-11-e01351-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/feb9/11101216/7aedc8facd2d/ac9-11-e01351-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/feb9/11101216/7aedc8facd2d/ac9-11-e01351-g001.jpg

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Clozapine-Related Functional Bowel Obstruction: A Rare Adverse Effect Unmasking Quetiapine and Benztropine Interaction Raising Need for Bowel Surveillance.氯氮平相关的功能性肠梗阻:一种罕见的不良反应揭示了喹硫平和苯海索的相互作用,增加了肠道监测的必要性。
ACG Case Rep J. 2024 May 17;11(5):e01351. doi: 10.14309/crj.0000000000001351. eCollection 2024 May.
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本文引用的文献

1
Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study.社区氯氮平起始的真实世界临床和成本效益:镜像队列研究。
Br J Psychiatry. 2022 Dec;221(6):740-747. doi: 10.1192/bjp.2022.47.
2
Efficacy and safety of clozapine in psychotic disorders-a systematic quantitative meta-review.氯氮平治疗精神障碍的疗效和安全性:系统定量荟萃评价。
Transl Psychiatry. 2021 Sep 22;11(1):487. doi: 10.1038/s41398-021-01613-2.
3
Cost effectiveness of pharmacogenetic-guided clozapine administration based on risk of HLA variants in Japan and the UK.
基于 HLA 变异风险的氯氮平药物遗传学指导给药的成本效果:日本和英国的研究。
Transl Psychiatry. 2021 Jul 7;11(1):362. doi: 10.1038/s41398-021-01487-4.
4
Clozapine as a first- or second-line treatment in schizophrenia: a systematic review and meta-analysis.氯氮平作为精神分裂症的一线或二线治疗:系统评价和荟萃分析。
Acta Psychiatr Scand. 2018 Oct;138(4):281-288. doi: 10.1111/acps.12954. Epub 2018 Sep 14.
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Management of common adverse effects of antipsychotic medications.抗精神病药物常见不良反应的管理。
World Psychiatry. 2018 Oct;17(3):341-356. doi: 10.1002/wps.20567.
6
Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study.氯氮平治疗的患者存在明显的胃肠动力不足,这可能是危及生命的胃肠道并发症的基础:一项横断面研究。
EBioMedicine. 2016 Feb 15;5:125-34. doi: 10.1016/j.ebiom.2016.02.020. eCollection 2016 Mar.
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Clozapine: balancing safety with superior antipsychotic efficacy.氯氮平:平衡安全性与卓越的抗精神病疗效。
Clin Schizophr Relat Psychoses. 2012 Oct;6(3):134-44. doi: 10.3371/CSRP.6.3.5.
8
Life-threatening clozapine-induced gastrointestinal hypomotility: an analysis of 102 cases.危及生命的氯氮平所致胃肠道动力不足:102例分析
J Clin Psychiatry. 2008 May;69(5):759-68. doi: 10.4088/jcp.v69n0509.
9
A model of anticholinergic activity of atypical antipsychotic medications.非典型抗精神病药物的抗胆碱能活性模型。
Schizophr Res. 2006 Dec;88(1-3):63-72. doi: 10.1016/j.schres.2006.07.011. Epub 2006 Aug 22.
10
Serum antimuscarinic activity during clozapine treatment.氯氮平治疗期间的血清抗毒蕈碱活性。
J Clin Psychopharmacol. 2003 Aug;23(4):336-41. doi: 10.1097/01.jcp.0000085405.08426.73.