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Treatment considerations in clozapine induced enuresis or incontinence

Published online by Cambridge University Press:  13 June 2014

Tunde D. Apantaku-Olajide*
Affiliation:
Dublin University Psychiatry Rotational Training Programme, Dublin, Ireland
*
*Correspondence Email: tunyapans@yahoo.com

Abstract

Antipsychotic related urinary symptoms are recognised and they remain a potential treatment-limiting sideeffect of clozapine. This article reports the incidence and management of two cases of clozapine-associated incontinence in psychiatrically stable patients. Both cases occurred during treatment and appear to have a similar pathophysiology, which may be related to the atypical nature of clozapine therapy. We searched the PubMed and MEDLINE databases for articles published from 1980 to 2008 that contain the keywords 'clozapine and enuresis, ‘clozapine and incontinence,’ ‘clozapine and seizures’. We also manually searched the bibliographies of these articles for related sources, and explored the reported treatment options to this side-effect of clozapine therapy. Both patients gave an informed consent.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2010

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References

reference

1.Kane, J, Honigfeld, G, Singer, Jet al.Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789–96.CrossRefGoogle ScholarPubMed
2.National Institute for Clinical Excellence. Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care. Clinical Guideline 1. London: NICE, 2002.Google Scholar
3.Aronowitz, JS, Safferman, AZ, Lieberman, JA. Management of clozapine-induced enuresis. Am J Psychiatry 1995; 152: 472473.Google ScholarPubMed
4.Konicki, PE, Borovicka, M, Fuller, M. Incidence and Treatment of Clozapine-Associated Urinary Incontinence. Presented at the 34th conference of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, December 1995.Google Scholar
5.Warner, JP, Harvey, CA, Barnes, TRE. Clozapine and urinary incontinence. Int Clin Psychopharmacol 1994; 9: 207209.Google ScholarPubMed
6.Steingard, S. Use of Desmopressin to treat Clozapine induced nocturnal enuresis. [Letter] J Clin Psychiat 1994; 55: 325–316.Google ScholarPubMed
7.Vera, PL, Miranda-Sousa, A, Nadelhaft, I. Effects of two atypical narcoleptics, olanzapine and risperidone, on the function of the urinary bladder and the external urethral sphincter in anesthetized rats. BMC Pharmacol 2001; 1: 4.CrossRefGoogle Scholar
8.Novartis Pharmaceuticals Corporation. Clozaril(R) (clozapine) Tablets [product monograph]. Dec 2003. www.pharma.us.novartis.com/product/pi/pdf/Clozaril.pdfGoogle Scholar
9.Wong, J, Delva, N. Clozapine-induced seizures: Recognition and Treatment. Can J Psychiat 2007; 52: 457463.CrossRefGoogle ScholarPubMed
10.Price, GW, Hills, S, Mann, PJ. The impact of clozapine on electrophysiological features: how can we utilize the findings? Int J Psychiat Clin Pract 2002; 6(2): 95102(8)CrossRefGoogle ScholarPubMed
11.Sandson, NBet al.Med-Psych Drug-Drug Interactions Update Clozapine Case Series 174. Psychosomatics 2007; 48(2) March-April.Google Scholar
12.Beach, PS, Beach, RE, Smith, LR. Hyponatremic seizures in a child treated with Desmopressin to control enuresis. A rational approach to fluid intake. Clin Paediat 1992; 31: 566569.Google Scholar
13.Frankenburg, FR, Kando, JC, Centorrino, F, Gilbert, JM. Bladder dysfunction associated with clozapine therapy. J Clin Psychiat 1996; 57: 3940.Google ScholarPubMed
14.English, BA, Still, DJ, Harper, J, Saklad SR, . Failure of Tolterodine to treat clozapineinduced nocturnal enuresis. Ann Pharmacother 2001; 35(7-8): 867869.CrossRefGoogle ScholarPubMed
15.Poyurovsky, M, Modai, I, Weizman, A. Trihyexyphenidyl as a possible therapeutic option in clozapine-induced nocturnal enuresis. Int Clin Psychopharmacol 1996; 11(1): 6163.CrossRefGoogle ScholarPubMed
16.Praharaj, SK, Arora, M. Amitriptyline for clozapine-induced nocturnal enuresis and sialorrhoea. Br J Clin Pharmacol 2007; 63(1): 128129.CrossRefGoogle ScholarPubMed
17.Devinsky, O, Honigfeld, G, Patin, J. Clozapine-related seizures. Neurology 1991; 41 (3): 369371Google ScholarPubMed