• Gijsbert J de Bruin, Dirk J Bac, Eugène P van Puijenbroek, and Johan M van der Klooster.
• Sint Franciscus Gasthuis, afd. Intensive Care, Rotterdam, The Netherlands.
• Ned Tijdschr Geneeskd. 2009 Jan 1; 153: B437.

AbstractClozapine is an antipsychotic drug which is used in the treatment of therapy-resistant schizophrenia. The most frequently reported side effects (occurring in more than 10% of patients) are gastro-intestinal complaints, including constipation. Here we describe the case of a 28-year-old man with schizophrenia who developed constipation and abdominal distension for several weeks while taking clozapine. He was admitted as an emergency suffering from clozapine-induced Ogilvie syndrome (acute pseudo-obstruction caused by a disturbed balance in the autonomic regulation of intestinal motility). Treatment on the intensive care unit was required because of septic shock and multiple organ dysfunction syndrome. Colonoscopy showed severe ischaemic colitis without signs of perforation or obstruction. Because conservative treatment with enemas, prokinetic drugs and antibiotics did not have sufficient effect, the cholinergic drug neostigmine was added to the treatment regimen. This led to a good clinical response, thereby averting the need for surgery. This case illustrates that decreased intestinal motility can be a severe problem for patients taking clozapine, which may lead to life-threatening complications.

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