Fatalities Associated With Clozapine-Related Constipation and Bowel Obstruction: A Literature Review and Two Case Reports

Background: Constipation is an exceedingly common side effect of treatment with clozapine. In rare cases, this side effect has resulted in fatal complications. Objective: The authors review the literature on fatal complications of clozapine-related constipation and bowel obstruction. Method: The authors provide two new case reports of patients who died of similar causes. Results: There were seven reports of deaths from clozapine-related bowel obstruction in the literature, with the most common mechanisms of death being severe impaction leading either to feculent vomiting or bowel necrosis. Discussion: The discussion outlines potential mechanisms and management of clozapine-related constipation. (Psychosomatics 2009; 50: 416-419)