- Pharmacodynamic interaction between clozapine and xanomeline/trospium may disrupt cholinergic and dopaminergic balance, precipitating catatonia in vulnerable patients.
- Clozapine's anticholinergic and GABAergic effects combined with xanomeline central muscarinic agonism create paradoxical receptor dysregulation.
- Clinical vigilance, early recognition, benzodiazepine trial, medication adjustment, and consideration of electroconvulsive therapy are essential management steps.
Prim Care Companion CNS Disord. 2026 Aug 11;28(4):26f04194. doi: 10.4088/PCC.26f04194.
ABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Prim Care Companion CNS Disord 2026;28(4):26f04194.
Author affiliations are listed at the end of this article.
PMID:42579811 | DOI:10.4088/PCC.26f04194
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