Zotepine-Associated Hypothermia in a Schizophrenic Inpatient

Antipsychotic-Related Hypothermia: Five New Cases

Background: Hypothermia is a potentially fatal adverse effect of antipsychotic drug (APD) use. With only 69 cases described in the literature, the condition is considered rare. Methods: We describe five new cases, in which we estimated the role of clozapine, haloperidol, olanzapine, penfluridol, risperidone, and zuclopentixol with the aid of two structured assessment tools. Results: In addition to APD use, all five patients described by us had been exposed to one or more additional predisposing factors for hypothermia. Therefore, with the aid of the assessment tools, the causal role of APDs was considered "possible" in four cases of moderate hypothermia and "doubtful" in the remaining one of mild hypothermia. Conclusion: Although the best way to detect APD-related hypothermia is measuring the body temperature for a duration of at least 7-10 days after the start (or a dose increase) of APDs, the use of assessment tools to identify additional predisposing factors for hypothermia and to thus establish their causal relationship with APD use would seem to be valuable for clinical decision-making (i.e., whether or not to discontinue APD use). Further research is needed to obtain reliable prevalence figures for APD-related hypothermia and its consequences, preferably in relation with physiological changes in body temperature.

The risk factors, frequency and diagnosis of atypical antipsychotic drug-induced hypothermia: practical advice for doctors

Hypothermia is unpredictable and life-threatening adverse effect of atypical antipsychotic drug (APD) treatment, which has been little described. The aim of this article is to increase the awareness that hypothermia induced by APD drugs is more common than the current published case reports may suggest, and risk factors increase its development. Moreover, valuable guidelines regarding how to detect the early stages of hypothermia in clinical practice are included. A literature search for reports on APD-induced hypothermia in PubMed, Academic Search Complete, Medline Complete and eHealthMe databases was conducted. The literature search apart from eHealthMe database resulted in 524 articles, which included 34 case reports. Hypothermia was mostly induced by olanzapine (14) and risperidone (10). However, the data from Food and Drug Administration reports revealed several dozen more cases of APD-induced hypothermia (591case reports) compared with the published case reports (e.g. olanzapine-262 and risperidone-161). Hypothermia, mostly mild (61% of cases), has developed mainly in men (71%) having schizophrenia, a few hours after commencement of treatment or in the presence of risk factors. Owing to the increased risk of hypothermia development during APD treatment, doctors should routinely measure body temperature of patients, especially during the first days of the therapy. Early diagnosis of hypothermia and appropriate treatment may prevent death.

Hypothermia due to Antipsychotic Medication: A Systematic Review

BACKGROUND

Hypothermia is a rare, but potentially fatal adverse effect of antipsychotic drug (APD) use. Although the opposite condition, hyperthermia, has been researched extensively in the context of the malignant antipsychotic syndrome, little is known about hypothermia due to APDs.

OBJECTIVE

This study aimed to review the literature on hypothermia in the context of APD use, and formulate implications for research and clinical care.

METHODS

A systematic search was made in PubMed and Ovid Medline.

RESULTS

The literature search yielded 433 articles, including 57 original case descriptions of hypothermia developed during APD use with non-toxic plasma levels. All cases together indicate that the risk of developing hypothermia is highest during the 7 days following initiation, or increase in dosage, of APDs, especially in the presence of additional predisposing factors, such as advanced age, exposure to cold, adjuvant use of benzodiazepines, and (subclinical) hypothyroidism. In addition, data derived from drug-monitoring agencies suggest that the prevalence of APD-related hypothermia is at least 10 times higher than suggested by the literature.

CONCLUSION

We conclude that health-care professionals need to monitor the body temperature of patients starting with (an increased dose of) APDs for a duration of 7-10 days to prevent hypothermia, especially in the presence of multiple risk factors. Moreover, systematic studies are needed to establish the actual prevalence of APD-related hypothermia as well as the relative risk for individual APDs.