Editing Clozapine (section)

===Gastrointestinal hypomotility===
Another underrecognized and potentially life-threatening effect spectrum is gastrointestinal hypomotility, which may manifest as severe [[constipation]], [[fecal impaction]], paralytic [[ileus]], [[bowel obstruction]], acute megacolon, [[ischemia]] or [[necrosis]].<ref>{{cite journal | vauthors = Palmer SE, McLean RM, Ellis PM, Harrison-Woolrych M | title = Life-threatening clozapine-induced gastrointestinal hypomotility: an analysis of 102 cases | journal = The Journal of Clinical Psychiatry | volume = 69 | issue = 5 | pages = 759–768 | date = May 2008 | pmid = 18452342 | doi = 10.4088/JCP.v69n0509 }}</ref> Colonic hypomotility has been shown to occur in up to 80% of people prescribed clozapine when [[gastrointestinal tract|gastrointestinal]] function is measured objectively using [[radiopaque]] markers.<ref>{{cite journal | vauthors = Every-Palmer S, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H, Ellis PM | title = Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study | journal = eBioMedicine | volume = 5 | pages = 125–134 | date = March 2016 | pmid = 27077119 | pmc = 4816835 | doi = 10.1016/j.ebiom.2016.02.020 }}</ref> Clozapine-induced gastrointestinal hypomotility currently has a higher mortality rate than the better known side effect of agranulocytosis.<ref>{{cite journal | vauthors = Cohen D, Bogers JP, van Dijk D, Bakker B, Schulte PF | title = Beyond white blood cell monitoring: screening in the initial phase of clozapine therapy | journal = The Journal of Clinical Psychiatry | volume = 73 | issue = 10 | pages = 1307–1312 | date = October 2012 | pmid = 23140648 | doi = 10.4088/JCP.11r06977 }}</ref> A [[Cochrane (organisation)|Cochrane review]] found little evidence to help guide decisions about the best treatment for gastrointestinal hypomotility caused by clozapine and other [[antipsychotic]] medication.<ref>{{cite journal | vauthors = Every-Palmer S, Newton-Howes G, Clarke MJ | title = Pharmacological treatment for antipsychotic-related constipation | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD011128 | date = January 2017 | pmid = 28116777 | pmc = 6465073 | doi = 10.1002/14651858.CD011128.pub2 }}</ref> Monitoring bowel function and the preemptive use of [[laxative]]s for all clozapine-treated people has been shown to improve colonic transit times and reduce serious sequelae.<ref>{{cite journal | vauthors = Every-Palmer S, Ellis PM, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H | title = The Porirua Protocol in the Treatment of Clozapine-Induced Gastrointestinal Hypomotility and Constipation: A Pre- and Post-Treatment Study | journal = CNS Drugs | volume = 31 | issue = 1 | pages = 75–85 | date = January 2017 | pmid = 27826741 | doi = 10.1007/s40263-016-0391-y | s2cid = 46825178 }}</ref>