Challenges associated with treating and preventing antipsychotic-induced constipation: considerations and cautions when prescribing novel interventions

Antipsychotic-induced constipation is a treatment-limiting side effect for patients with serious mental illness (SMI). In addition to increased risk of constipation, due to adverse medication effects, individuals diagnosed with SMI are also prone to lifestyle factors that contribute to this medical complication. The USA Food and Drug Administration (FDA) recently released enhanced warnings about the risk of serious, sometimes fatal, complications associated with constipation caused by the antipsychotic, clozapine. It is likely this heightened warning will prompt providers to seek additional means to prevent and treat antipsychotic-induced constipation, despite having no agent with FDA approval for this specific indication. Off-label prescribing of newer medications for the treatment of antipsychotic-induced constipation is associated with risks, many of which are still unknown, considering the exclusion of patients with SMI in studies measuring nonpsychiatric outcomes.