Failure of tolterodine to treat clozapine-induced nocturnal enuresis

OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of...

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Bibliographic Details
Published in:The Annals of pharmacotherapy 2001-07, Vol.35 (7), p.867-869
Main Authors: English, BA, Still, DJ, Harper, J, Saklad, SR
Format: Article
Language:English
Subjects:
Adolescent
Antipsychotic Agents - adverse effects
Benzhydryl Compounds - therapeutic use
Biological and medical sciences
Clozapine - adverse effects
Cresols - therapeutic use
Drug toxicity and drugs side effects treatment
Enuresis - chemically induced
Enuresis - drug therapy
Female
Humans
Medical sciences
Muscarinic Antagonists - therapeutic use
Pharmacology. Drug treatments
Phenylpropanolamine
Psychotic Disorders - drug therapy
Tolterodine Tartrate
Toxicity: urogenital system
Treatment Failure
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Summary:OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. Clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms. DISCUSSION: This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence. CONCLUSIONS: Nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction.
ISSN:1060-0280
1542-6270
DOI:10.1345/aph.10304