Treatment considerations in clozapine induced enuresis or incontinence

Apantaku-Olajide, Tunde

doi:10.1017/s0790966700001154

Cited by 2 publications

(5 citation statements)

References 10 publications

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“…Clozapine dose ranged from 50 to 900 mg. Clozapine plasma levels were reported in seven patients and ranged from 290 to 760 ug/L. 14,[21][22][23][24] Seven studies were recorded in an inpatient setting, [23][24][25][26][27][28] and one in an outpatient setting, 29 whereas the remaining studies did not report the setting. Timing of enuresis ranged from 1 to 90 days after commencement of clozapine (median: 21 days).…”

Section: Resultsmentioning

confidence: 99%

“…All three patients experienced complete resolution of symptoms. One case used a dose of 500 mg three times a day, 14 and the other did not report the dose 21 . Neither study reported on adverse effects.…”

Section: Pharmacological Interventionsmentioning

confidence: 95%

“…One case used a dose of 500 mg three times a day, 14 and the other did not report the dose. 21 Neither study reported on adverse effects.…”

Section: Sodium Valproatementioning

confidence: 98%

“…Symptoms completely resolved in all 10 patients. Three other publications 21 , 22 , 26 reported data for four patients whom previously trialed oxybutynin without success. No studies reported on adverse effects.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…One case series and one case study 14 , 21 used sodium valproate, an anticonvulsant, with data for three patients. Two patients suffered from tonic–clonic seizures, and another had inconclusive EEG activity, and were started on sodium valproate.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

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Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

et al. 2022

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Background Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug reactions, including nocturnal enuresis and urinary incontinence. This side effect can be burdensome and lead to medication nonadherence and psychotic relapse. Evidence to guide treatment of clozapine-induced nocturnal enuresis and urinary incontinence is sparse. We therefore aimed to synthesize the evidence base to guide management for clinicians, patients, and their carers. Methods We systematically searched PubMed, Embase, PsycInfo, CINAHL, and the Cochrane Trial Registry databases from inception to May 2021 for publications on management of clozapine-induced nocturnal enuresis and urinary incontinence using a PROSPERO preregistered search strategy. Results We identified 22 case reports and case series describing 74 patients. Interventions included clozapine dose reduction, nonpharmacological treatment, and pharmacological treatments. Among pharmacological treatments, desmopressin, oxybutynin, trihexyphenidyl, tolterodine, imipramine, amitriptyline, ephedrine, pseudoephedrine, aripiprazole, and verapamil were associated with complete resolution of nocturnal enuresis and urinary incontinence. Balancing evidence for effectiveness against risk of adverse effects, we developed a management framework for clozapine-induced nocturnal enuresis and urinary incontinence. Conclusions Following assessment of urological, psychiatric, pharmacological, and common comorbid medical issues, first-line treatments should be nonpharmacological, including bathroom alarms, voiding before bedtime, and nocturnal fluid restriction. If these interventions do not provide adequate relief, aripiprazole should be trialed. Desmopressin may be considered for severe refractory cases, but monitoring for hyponatremia is essential.

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