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Review

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

1
GKT School of Medical Education Department, King’s College London University, London SE1 1UL, UK
2
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
3
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
4
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
5
National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
6
Toxicology Unit, Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Domenico De Berardis
Int. J. Mol. Sci. 2016, 17(6), 863; https://doi.org/10.3390/ijms17060863
Received: 13 March 2016 / Revised: 13 May 2016 / Accepted: 16 May 2016 / Published: 2 June 2016
(This article belongs to the Special Issue Antipsychotics)
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. View Full-Text
Keywords: constipation; clozapine; treatment-resistant schizophrenia; adverse events; systematic review; meta-analysis constipation; clozapine; treatment-resistant schizophrenia; adverse events; systematic review; meta-analysis
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MDPI and ACS Style

Shirazi, A.; Stubbs, B.; Gomez, L.; Moore, S.; Gaughran, F.; Flanagan, R.J.; MacCabe, J.H.; Lally, J. Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis. Int. J. Mol. Sci. 2016, 17, 863. https://doi.org/10.3390/ijms17060863

AMA Style

Shirazi A, Stubbs B, Gomez L, Moore S, Gaughran F, Flanagan RJ, MacCabe JH, Lally J. Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis. International Journal of Molecular Sciences. 2016; 17(6):863. https://doi.org/10.3390/ijms17060863

Chicago/Turabian Style

Shirazi, Ayala, Brendon Stubbs, Lucia Gomez, Susan Moore, Fiona Gaughran, Robert J. Flanagan, James H. MacCabe, and John Lally. 2016. "Prevalence and Predictors of Clozapine-Associated Constipation: A Systematic Review and Meta-Analysis" International Journal of Molecular Sciences 17, no. 6: 863. https://doi.org/10.3390/ijms17060863

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