Clozapine Reactions 1680, p96 - 2 Dec 2017 Sedation: case report A woman in her 60s [exact age at the time of event onset not stated] developed sedation during treatment with clozapine. Later, she died due to asphyxia following choking on a handkerchief. The woman, who had a history of chronic schizophrenic psychosis, was receiving treatment with oral clozapine three tablets of 100mg, and lorazepam. In January 2010, her caregiver found her sitting on a couch and coughing loudly and persistently, with her hands around her neck. She tried to explain the caregiver that she had a handkerchief in her throat and was choking. She had forced the handkerchief down her pharynx to silence the voices of spirits. Her husband attempted to pull the paper handkerchief out of her throat, and called the emergency medical services. Later, she died due to suffocation produced by the handkerchief. The toxicological data revealed that at the time of choking, she was in a state of sedation, which was considered secondary to the use of clozapine. Further it was considered that, the state of sedation reduced her capacity to defend herself and possibly develop self-rescue manoeuvres. It was not confirmed that, the woman inserted the handkerchief for suicidal purpose or to buffer the bleeding in her mouth on the upper left canine, but the forced insertion of the handkerchief down her pharynx resulted in asphyxia and death. Her autopsy showed abundant red wine hypostases localised on the face, neck and upper chest with absence of upper left canine and lower left premolar. The histological examinations further confirmed multi-organ congestion and sub-pleural emphysema. Toxicological analyses demonstrated three times higher doses of clozapine in her blood at the time of her death (0.9 mg/mL), indicating her prescribed dosage of 300 mg/day. Author comment: "[T]he woman was not completely unconscious but was in a state of sedation." "[T]he patient could have put the handkerchief in her mouth on the upper left canine to buffer the bleeding, but being under the influence of the drug Clozapine (side effects: drowsiness), it fatally blocked the airway causing early asphyxia, mechanical, violent internal suffocation." De Donno A, et al. A singular case of asphyxia by choking on a handkerchief: Accidental event or suicide to "shut-up" spirits. Clinica Terapeutica 168: e293-296, No. 5, Sep-Oct 2017. Available from: URL: - Italy 803285014 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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