Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis

• Published in: International journal of molecular sciences Vol. 17; no. 6; p. 863
• Main Authors: Shirazi, Ayala, Stubbs, Brendon, Gomez, Lucia, Moore, Susan, Gaughran, Fiona, Flanagan, Robert J, MacCabe, James H, Lally, John
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 02.06.2016; MDPI
• Subjects: adverse events; Antipsychotic Agents - adverse effects; clozapine; Clozapine - adverse effects; Constipation; Constipation - chemically induced; Constipation - epidemiology; Epidemiology; Humans; Meta-analysis; Odds Ratio; Prevalence; Psychotropic drugs; Review; Schizophrenia; Schizophrenia - complications; Schizophrenia - drug therapy; Serotonin Antagonists - adverse effects; Side effects; systematic review; treatment-resistant schizophrenia; constipation; meta-analysis; clozapine; treatment-resistant schizophrenia; adverse events; systematic review
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms17060863

Constipation is a frequently overlooked side effect of clozapine treatment that can prove fatal. We conducted a systematic review and meta-analysis to estimate the prevalence and risk factors for clozapine-associated constipation. Two authors performed a systematic search of major electronic databases from January 1990 to March 2016 for articles reporting the prevalence of constipation in adults treated with clozapine. A random effects meta-analysis was conducted. A total of 32 studies were meta-analyzed, establishing a pooled prevalence of clozapine-associated constipation of 31.2% (95% CI: 25.6-37.4) (n = 2013). People taking clozapine were significantly more likely to be constipated versus other antipsychotics (OR 3.02 (CI: 1.91-4.77), p < 0.001, n = 11 studies). Meta-regression identified two significant study-level factors associated with constipation prevalence: significantly higher (p = 0.02) rates of constipation were observed for those treated in inpatient versus outpatient or mixed settings and for those studies in which constipation was a primary or secondary outcome measure (36.9%) compared to studies in which constipation was not a specified outcome measure (24.8%, p = 0.048). Clozapine-associated constipation is common and approximately three times more likely than with other antipsychotics. Screening and preventative strategies should be established and appropriate symptomatic treatment applied when required.