olanzapine and Nocturnal-Enuresis

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

Risperidone appears to be effective in treating behavioral problems in children with autistic disorder. Although increased appetite, weight gain, and sedation are among the most common side effects, risperidone-induced enuresis is rarely reported.. We will present two cases with risperidone-induced enuresis, and discuss our findings in the context of current literature.. Two children aged 11 and 10 years, diagnosed with autism and mental retardation, have developed new-onset diurnal and nocturnal enuresis respectively on their first and second weeks of risperidone monotherapy (1.5 and 1 mg/day). They did not experience sedation, and their medical history and workup were unremarkable. As enuresis did not resolve spontaneously, we decided to substitute risperidone with olanzapine. Enuresis ceased rapidly after discontinuation of risperidone with no emergence when patients were treated with olanzapine 5 mg/day for a period of 6 months and 1 year, respectively.. Although the pathophysiology of antipsychotic-induced enuresis remains unclear, a number of mechanisms including alpha(1)-adrenergic blockade, dopamine blockade, and antimuscarinic effects has been proposed. Olanzapine has lower alpha(1)-adrenergic and dopaminergic blockade properties, thus changing risperidone to olanzapine may be an alternative modality in risperidone-induced enuresis when antipsychotic treatment is crucial. Clinicians should be more vigilant about screening for this side effect, especially in younger population with developmental disabilities.

Topics: Antipsychotic Agents; Autistic Disorder; Benzodiazepines; Child; Diurnal Enuresis; Humans; Intellectual Disability; Male; Nocturnal Enuresis; Olanzapine; Receptors, Adrenergic, alpha-1; Receptors, Dopamine; Receptors, Muscarinic; Risperidone