Reintroduction of Clozapine After Perforation of the Large Intestine—A Case Report and Review of the Literature

OBJECTIVETo report on a patient who was successfully rechallenged with clozapine after perforation of the large intestine and pulmonary embolism postoperatively, and provide a literature review on clozapine rechallenge.CASE SUMMARYA 46-year-old Japanese man with treatment-resistant schizophrenia developed constipation and slight abdominal discomfort while taking clozapine 275 mg/day. He developed appendicitis, leading to perforation of the large intestine. During the postsurgery period, a partial embolism of the pulmonary artery was revealed. The patient's constipation was relieved when clozapine was discontinued, but other antipsychotics failed to control his delusions well. After thorough discussion, it was decided to rechallenge with clozapine. The low dose of clozapine 200 mg/day was tolerable for his delusion, and his constipation was managed with laxatives and exercises until 8 months after the accident.DISCUSSIONClozapine is a gold standard medication in treatment-resistant schizophrenia but is ass...