Katie Evans and Lee Griffiths
Cardiff and Vale University Health Board
Clozapine is the gold standard treatment for treatment resistant Schizophrenia, people who develop intolerable neurological side-effects with other antipsychotics and psychosis in Parkinson’s disease. A side effect; Clozapine Induced Gastrointestinal Hypomotility (CIGH) is defined by slow gastrointestinal transit and can affect up to 80% of people prescribed clozapine. CIGH is most often associated with constipation, but symptoms can vary in severity from dyspepsia to severe and potentially life-threatening complications such as faecal impaction, paralytic ileus and intestinal obstruction. Between 1992 and 2017 there were there 527 cases of potentially harmful CIGH cases reported to the MHRA, with 172 of these cases resulting in death.
Patient reported symptoms and use of rating scales have poor detection sensitivity and this, in-part, may be due to clozapine’s anti-serotonergic activity impairing gut nociception. Given the proportion of patients affected, detection issues and potential severity; prophylactic laxatives have been proposed with protocol developed in New Zealand. In Cardiff and Vale, this protocol was adapted for use and has been in place since 2020/21 for all patients prescribed clozapine.
This project aims to evaluate the use of the Cardiff and Vale Clozapine Constipation protocol with a view to develop an all-Wales protocol for prophylactic laxatives use in this patient group.
This will be undertaken by assessing the uptake of the clozapine constipation pathway to practice and attaining feedback from patients and clinicians who have experienced its use. The result of the above, the evolving evidence base and the experiences of various stakeholders nationally will then help inform the co-production of an All- Wales CIGH Prevention and Treatment Laxative Protocol.
The anticipated benefit is to reduce the risk of CIGH for people prescribed clozapine in Wales.
