Translation of a-t 2026; 57: 56

Neuroleptics: actively ask about constipation

The French drug authority ANSM recalls the risk of constipation that may occur in patients treated with neuroleptics which may lead to serious complications including death.¹ Despite a warning from the national health authority in 2022, the ANSM continues to receive reports of this type.^1,2

According to the authority, all neuroleptics carry the potential for constipation, which can be severe, due to their anticholinergic properties.¹ The risk increases when combined with medicinal products that also have an anticholinergic or constipating effect.³ Patients from the age of 60 are at particular risk.¹ Since neuroleptics are approved not just for schizophrenia and bipolar disorders but also for delirious and aggressive conditions, dementia, Huntington's disease and other diseases,^4-6 there are many different risk scenarios.

The anticholinergic effect is substance-dependent, but constipation is listed as common in the summaries of product characteristics for antipsychotics prescribed broadly.^4-6 Clozapine (LEPONEX, generics; see a-t 1999; 5: 56) has a strong anticholinergic effect, and according to a warning from the US drug authority the FDA, it can lead in rare cases to serious bowel complications as a result of constipation even without other anticholinergic drugs. In other antipsychotics, these complications were only observed in combination with other anticholinergic medicinal products.³

The ANSM recommends checking the anticholinergic burden of all medicinal products prescribed, for example using a suitable score or calculator.^{1, e.g. 8} Sufficient fluid intake, a high-fibre diet and, if possible, physical exercise are important. Suitable prophylaxis should be started at the beginning of treatment where there is an increased risk of constipation.¹ Patients should be asked about their bowel movements regularly, even if they do not express any discomfort. They should also be warned about possible warning signs. In addition to abdominal pain and a reduction in the frequency of bowel movements (in particular less than three times a week), these include hard or dry stools, not passing wind, fever, nausea, vomiting, a swollen stomach and unexplained diarrhoea. If symptoms of this type occur, medical advice should be sought quickly so that serious complications can be identified and treated early.^1,3

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