Warning Over Schizophrenia Drug Clozapine

[HA]

Warning Over Schizophrenia Drug Clozapine
7:28 am, 01 Apr 2007 Print this story

Health professionals are being urged to monitor patients on a schizophrenia drug after a review found five people have died from its side-effects.

The Intensive Medicines Monitoring Programme says one person has died from an acute blood disorder, as a result of using Clozapine.

It says four other deaths were caused by another side effect, severe constipation.

Pete Ellis, from the University of Otago and Wellington School of Medicine, says health professionals need to be aware of the potential complications.

He says it is has been acknowledged the drug can cause constipation, but this is the first evidence that it can be fatal.

Mr Ellis says health professionals can still confidently prescribe the drug but should discuss whether it is causing significant side effects with patients.

 

[David Baxter PhD]

This is nothing new. Clozapine is at present the only medication for schizophrenia that can address the negative symptoms.

There are known side-effects which need to be monitored. In both the US and Canada, this included mandatory monitoring of white blood cell coounts for the first year. In Ontario, every prescription must be pre-approved and the patient is hospitalized for the first three days to monitor any adverse reactions.

Why would a doctor choose to prescribe a medication with potentially dangerous side-effects? Because the actual risk of those side-effects is low and the benefits for all those who do not experience the side-effects can be enormous.

To put it into context, drugs used to treat cancer and prevent the recurrence of breast cancer also come with the risk of potentially fatal side-effects. They are used for the same reason - because when they work, the benefits are large.

 

[HA]

My son has been on this drug for a number of years and it is what I consider "a miracle drug" because no other drug has worked on the positive symptoms even. He is treatment resistent.

Agranulocytosis is very rare at .03%. It can occur with many other drugs including tylenol but because there were these rare incidents of death from this blood condition the required blood monitoring is now in place and the condition can be detected and stopped.

With this report what is new is that deaths have ocurred as a result of "constipation". Clozapine can have an affect on peristalsis, which is the intestines way of moving food through the body. Constipation has been a problem for my son and it can be severe at times. Medication is taken to address it but too much of this medication can cause dependence which means the intestines will not work on they're own once dependence has been established so they won't give him more.

The staff do not monitor bowel movements and only address complaints and even then they are not considered to be an issue and he recently went through a very difficult time.

My concern here is that as noted by this clinician, deaths have resulted and it may be that monitoring of bowel movements may have prevented these deaths.

From http://www.drugs.com/pro/clozapine.html#section-10

Gastrointestinal
Clozapine use has been associated with varying degrees of impairment of intestinal peristalsis, ranging from constipation to intestinal obstruction, fecal impaction and paralytic ileus (see ADVERSE REACTIONS). On rare occasions, these cases have been fatal. Constipation should be initially treated by ensuring adequate hydration, and use of ancillary therapy such as bulk laxatives. Consultation with a gastroenterologist is advisable in more serious cases.

 

[David Baxter PhD]

My apologies, Judy. I was under the impression that this was a known risk, and there are of course a few of them. And I do thank you for posting this article and raising the issue of the costs versus benefits of medications like these.

In one of the other articles I read on clozapine, a psychiatrist said, "I believe that everyone deserves a chance on clozapine" because it has the potential to significantly enhance quality of life for patients beyond any other currently available medications.

But there is no doubt whatsoever that patients taking this medication must be carefully monitored, for at least the first year and perhaps for as long as they require the medication.

My stepson is scheduled for a trial with clozapine later this year. He has been doing well on his medication but I agree with that psychiatrist - he deserves a chance at clozapine which holds out the promise for a much more "normal" life (however one defines that).

 

[HA]

Dr Baxter, I'm glad you brought this up because others would have thought the same thing and I was not about to just start talking about my personal experience with "constipation", :red: but it is important to be aware of this.

I also agree that Clozapine is one of the better medications and everyone should have the opportunity to try this one. I wish we had of had this one as the very first medication trial.