<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0535-5133</journal-id>
<journal-title><![CDATA[Investigación Clínica]]></journal-title>
<abbrev-journal-title><![CDATA[Invest. clín]]></abbrev-journal-title>
<issn>0535-5133</issn>
<publisher>
<publisher-name><![CDATA[Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del Zulia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0535-51332024000400470</article-id>
<article-id pub-id-type="doi">10.54817/ic.v65n4a08</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Severe necrotic colitis in an adolescent with polypharmacy and high clozapine doses according to his ancestry.]]></article-title>
<article-title xml:lang="es"><![CDATA[Severa colitis necrotizante en un adolescente con polifarmacia y dosis elevada de clozapina con relación a su origen étnico.]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Baptista]]></surname>
<given-names><![CDATA[Trino]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A a"/>
<xref ref-type="aff" rid="A3"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[de Leon]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guizar]]></surname>
<given-names><![CDATA[Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Evia]]></surname>
<given-names><![CDATA[Laura]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Los Andes Facultad de Medicina Departamento de Fisiología]]></institution>
<addr-line><![CDATA[Mérida ]]></addr-line>
<country>Venezuela</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Clínica NeuroORIGEN  ]]></institution>
<addr-line><![CDATA[Querétaro ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Anáhuac Querétaro Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Querétaro ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Mental Health Research Center at Eastern State Hospital  ]]></institution>
<addr-line><![CDATA[Lexington KY]]></addr-line>
<country>USA</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,University of the Basque Country  ]]></institution>
<addr-line><![CDATA[Vitoria ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Universidad Americana de Europa (UNADE)  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>65</volume>
<numero>4</numero>
<fpage>470</fpage>
<lpage>475</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://ve.scielo.org/scielo.php?script=sci_arttext&amp;pid=S0535-51332024000400470&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://ve.scielo.org/scielo.php?script=sci_abstract&amp;pid=S0535-51332024000400470&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://ve.scielo.org/scielo.php?script=sci_pdf&amp;pid=S0535-51332024000400470&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract The antipsychotic drug Clozapine (CLZ) is approved for treatment-resistant schizophrenia and reduction in the risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. However, it is increasingly used in psychiatry and neurology worldwide in numerous off-label conditions. Clozapine is associated with diverse side effects which require careful monitoring in its use for prevention and treatment. The quality of CLZ use and pharma- covigilance varies considerably among Latin American countries. CLZ-induced gastrointestinal hypomotility (CIGH) is a relevant clinical problem, ranging from innocuous constipation to lethal necrotic colitis. Thus, optimal prevention, early detection, and treatment of CIGH deserves considerable attention. We describe here the case of a 15-year-old Mexican boy diagnosed with Oppositional Defiant- and Attention-Deficit/Hyperactivity Disorder who developed severe necrotic colitis after nine months of CLZ treatment, leading to permanent ileostomy. We ascribed this unfortunate outcome to careless polypharmacy that did not consider drug-related antimuscarinic activity, deficient clinical monitoring, and lack of attention to ethnicity concerning drug dosing. This case is of educational value for the mental health team in order to promote the proper use of CLZ, which may be life-saving in patients with severe mental disorders.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El antipsicótico Clozapina (CLZ) está aprobado en el tratamiento de la esquizofrenia resistente y para reducir el riesgo suicida en esta condición y en el trastorno esquizoafectivo. Sin embargo, su uso no aprobado en psiquiatría y neurología ha aumentado recientemente en todo el mundo. La CLZ se asocia a diversos efectos indeseables, los cuales ameritan monitorización cuidadosa para su prevención y tratamiento. La hipomotilidad gastrointestinal (HMGI) asociada al uso de Clozapina (CLZ), es un problema clínico relevante que se manifiesta desde un nivel de constipación inocua hasta colitis necrotizante letal. En consecuencia, la prevención óptima, detección temprana y el tratamiento de la HMGI amerita atención considerable. Presentamos el caso de un adolescente mexicano de 15 años con los diagnósticos de Trastornos Oposicionista-Desafiante y Déficit de Atención con Hiperactividad, que desarrolló colitis necrotizante severa que condujo a ileostomía permanente luego de 9 meses de tratamiento con CLZ. Atribuimos este cuadro clínico al uso inadecuado de polifarmacia en donde no se valoró adecuadamente al efecto antimuscarínico de los medicamentos, y al desconocimiento del impacto de grupo étnico en la dosificación de la CLZ. Este caso clínico es de valor educativo para el equipo de salud mental, con el fin de promover el uso adecuado de la CLZ, que puede ser una medida vital en pacientes con enfermedades mentales severas.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[clozapine]]></kwd>
<kwd lng="en"><![CDATA[constipation]]></kwd>
<kwd lng="en"><![CDATA[colitis]]></kwd>
<kwd lng="en"><![CDATA[ethnicity]]></kwd>
<kwd lng="en"><![CDATA[polypharmacy]]></kwd>
<kwd lng="es"><![CDATA[clozapina]]></kwd>
<kwd lng="es"><![CDATA[colitis]]></kwd>
<kwd lng="es"><![CDATA[constipación]]></kwd>
<kwd lng="es"><![CDATA[etnicidad]]></kwd>
<kwd lng="es"><![CDATA[polifarmacia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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