clozapine and Nocturnal-Enuresis

This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.

Topics: Antipsychotic Agents; Clozapine; Constipation; Humans; Nocturnal Enuresis; Sialorrhea; Tachycardia

Nocturnal enuresis can be discomfiting and troublesome. There is increasing evidence that as a side-effect of second-generation antipsychotics, particularly clozapine, it may be underrecognised. Direct but sensitive questioning may be required to elicit this side-effect. We briefly review possible mechanisms of this problem, and management and treatment options.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dibenzothiazepines; Female; Humans; Male; Nocturnal Enuresis; Risperidone

Topics: Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Clozapine; Dibenzothiazepines; Humans; Nocturnal Enuresis; Olanzapine; Quetiapine Fumarate; Risperidone

Nocturnal enuresis has been reported in patients taking clozapine, but the incidence has not been accurately established. The incidence of enuresis in patients taking risperidone, olanzapine or quetiapine is unknown. Aims To compare nocturnal enuresis in patients taking clozapine with that in patients taking risperidone, olanzapine or quetiapine.. Observational cohort study using prescription event monitoring methods. Patients prescribed atypical antipsychotic medicines were followed up by questionnaires that were sent to their medical practitioner. Practitioners were asked to directly ask their patients about bed-wetting.. Nocturnal enuresis was reported by 17 of 82 (20.7%) patients taking clozapine, 11 of 115 (9.6%) taking olanzapine, 7 of 105 (6.7%) taking quetiapine and 12 of 195 (6.2%) taking risperidone. Compared with clozapine, the risk of nocturnal enuresis was significantly lower in patients taking olanzapine (odds ratio, OR = 0.43, 95% CI 0.19-0.96), quetiapine (OR = 0.33, 95% CI 0.13-0.59) or risperidone (OR = 0.27, 0.12-0.59), with odds ratios adjusted for age, gender and duration of treatment.. Approximately one in five patients prescribed clozapine experienced bed-wetting. This was significantly higher than the rate of nocturnal enuresis in patients taking olanzapine, quetiapine or risperidone.

Topics: Adolescent; Adult; Antipsychotic Agents; Benzodiazepines; Child; Clozapine; Cohort Studies; Dibenzothiazepines; Female; Humans; Incidence; Male; Middle Aged; New Zealand; Nocturnal Enuresis; Olanzapine; Product Surveillance, Postmarketing; Quetiapine Fumarate; Risperidone; Urban Population; Young Adult

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dibenzothiazepines; Female; Humans; Male; Nocturnal Enuresis; Risperidone

Topics: Amitriptyline; Antipsychotic Agents; Clozapine; Humans; Male; Muscarinic Antagonists; Nocturnal Enuresis; Schizophrenia; Sialorrhea; Trihexyphenidyl; Young Adult

Topics: Adult; Amitriptyline; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Clozapine; Drug Administration Schedule; Humans; Male; Nocturnal Enuresis; Sialorrhea