From the Guidelines
Yes, nocturnal enuresis can be a side effect of certain antipsychotic medications, as evidenced by the fact that medications such as clozapine have been reported to cause secondary enuresis 1.
Mechanism and Risk Factors
The risk of developing nocturnal enuresis as a side effect of antipsychotic medications appears to be dose-dependent, with higher doses increasing the likelihood of this problem. Antipsychotics can cause enuresis through several mechanisms, including sedation, anticholinergic effects, and antagonism of alpha-1 adrenergic receptors.
- Sedation deepens sleep and reduces arousal to bladder signals.
- Anticholinergic effects can cause urinary retention followed by overflow incontinence.
- Antagonism of alpha-1 adrenergic receptors affects bladder and urethral sphincter function.
Management Options
Management options for patients experiencing nocturnal enuresis as a side effect of antipsychotic medications include:
- Reducing the medication dose if possible.
- Changing the timing of administration to earlier in the day.
- Switching to an alternative antipsychotic with less risk.
- Adding medications like desmopressin, oxybutynin, or imipramine to control the enuresis. Patients should be encouraged to limit fluid intake in the evening and void before bedtime. Addressing this side effect promptly is crucial as it can significantly impact quality of life and medication adherence in patients requiring antipsychotic treatment. It is also important to consider the psychological factors that may contribute to enuresis, as some children with enuresis may have underlying psychological issues that need to be addressed 1.
From the FDA Drug Label
Renal and Urinary Disorders: frequent – enuresis The FDA drug label for aripiprazole indicates that enuresis (which includes nocturnal enuresis) can be a side effect of the medication, particularly in pediatric patients.
- Enuresis is listed as a frequent side effect in the pediatric population.
- The label does not provide further details on the incidence or severity of enuresis in patients taking aripiprazole. 2
From the Research
Nocturnal Enuresis as a Side Effect of Psychotic Medications
- Nocturnal enuresis can be a side effect of antipsychotic medications, particularly second-generation antipsychotics like clozapine 3.
- The exact mechanisms of antipsychotic-induced nocturnal enuresis are not fully understood, but possible mechanisms include alpha(1)-adrenergic blockade, dopamine blockade, and antimuscarinic effects 4.
- Several case reports and studies have documented the occurrence of nocturnal enuresis with various antipsychotic medications, including:
Management and Treatment Options
- Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence include nonpharmacological interventions, such as bathroom alarms, voiding before bedtime, and nocturnal fluid restriction 6.
- Pharmacological treatments that have been associated with complete resolution of nocturnal enuresis and urinary incontinence include:
- Clinicians should be vigilant about screening for nocturnal enuresis as a side effect of antipsychotic medications, especially in younger populations with developmental disabilities 4.