Raúl Alberto Estevez-Cordero, Teresa Morera-Herreras
Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
Rafael Hernandez
Internal Medicine Service. Araba Psychiatric Hospital. Araba Mental Health Network, C/alava 43, 01006 Vitoria-Gasteiz. Alava. Spain
Juan Medrano
Biocruces Bizkaia Health Research Institute, Mental Health Network Research Group, Osakidetza, Bizkaia, Spain
Susanna Every-Palmer
Head of Department. Department of Psychological Medicine, University of Otago, Wellington, New Zealand
Unax Lertxundi
Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
Abstract:
Introduction: In recent years, higher rates of mortality have been recorded from clozapine-induced gastrointestinal hypomotility than from agranulocytosis. Still, this adverse reaction does not receive enough attention. Some authors recommend prophylactic laxatives for every clozapine-treated patient but little information exists about laxative use in this patient cohort. Methods: To conduct this study we identified all patients treated with clozapine of Araba, Northern Spain. To identify eligible patients we used PRESBIDE which contains all outpatient prescription medications funded or not by the drug benefit plan. We measured the medication possession ratio (MPR) as an indirect measure of adherence both for clozapine and other medications including laxatives. Results: A total of 217 clozapine-treated outpatients were included. Mean age was almost 47 years, and about three-quarters were male. The most frequent reason for clozapine use was schizophrenia, and mean duration of clozapine treatment was 4.5 years. Six of the 217 patients (2.7 %) had a laxative prescription, with a mean MPR of 8.4% in this therapeutic class. Conclusions: Laxatives were under-utilized and adherence was poor. We recommend healthcare professionals educate clozapine-treated patients and their families as to the risks of gastrointestinal hypomotility, offer prophylactic laxatives and advise patients to take them as prescribed.
Keywords:Laxatives, constipation, clozapine, adherence, gastrointestinal hypomotility