Reactions 1014 - 14 Aug 2004

★ SClomipramine/clozapine

Dysphagia (first report with clomipramine): casereport

A 64-year-old man developed dysphagia and consequentrespiration pneumonia during long-term treatment withclozapine for chronic schizophrenia and clomipramine fordepression.

The man, who had received clozapine 200–375 mg/day forapproximately 10 years, along with clomipramine75–200 mg/day, presented after an episode of choking, severedyspnoea and dysphagia; 4 years earlier he had experienceddifficulty swallowing, recurrent episodes of regurgitation, andhiccups. A chest x-ray revealed severe bilateral upper lobeconsolidation with air bronchograms, consistent withaspiration pneumonia. He was transferred to the ICU, where aCT scan showed marked dilatation of his entire oesophagus,with liquid and solid material filling the lumen, and he receivedrespiratory support for 6 days. Subsequent oesophagealvideofluoroscopy showed minimal pharyngeal retention ofbarium and impaired oesophageal clearance.

The man was treated with domperidone and received apercutaneous endoscopic gastrostomy and nutritionalsupport. Manometry revealed severe oesophagealhypomotility and an insufficient lower oesophageal sphincter.Clomipramine was tapered and discontinued, and hisclozapine dose was decreased to 300 mg/day. Six weeks later,manometry showed improved oesophageal motility andrecovery of peristalsis and, at follow-up, his dysphagia hadresolved.

Author comment: "We consider that the combination ofclozapine and clomipramine contributed to the severeesophageal dysmotility suffered by this patient."Maddalena AS, et al. Esophageal dysfunction on psychotropic medication: a casereport and literature review. Pharmacopsychiatry 37: 134-138, No. 3, May 2004 -Switzerland 800981574

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of dysphagia associatedwith clomipramine. The WHO Adverse Drug Reactions databasecontained 14 reports of dysphagia associated withclomipramine.

1

Reactions 14 Aug 2004 No. 10140114-9954/10/1014-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved