Can Seroquel (quetiapine) cause nocturnal enuresis?

Quetiapine Can Cause Nocturnal Enuresis (Bedwetting)

Yes, Seroquel (quetiapine) can cause nocturnal enuresis (bedwetting) as documented in its FDA label as a post-marketing adverse reaction.1

Evidence from Drug Label

The FDA label for quetiapine explicitly lists nocturnal enuresis among the adverse reactions identified during post-approval use of the medication. These reactions were "temporally related to quetiapine therapy" although the label notes that because these are voluntarily reported from a population of uncertain size, it's not always possible to reliably establish frequency or definitive causal relationship 1.

Comparative Risk Among Atypical Antipsychotics

Research shows that quetiapine has a significant association with nocturnal enuresis, though at a lower rate than clozapine:

• Clozapine: 20.7% of patients
• Olanzapine: 9.6% of patients
• Quetiapine: 6.7% of patients
• Risperidone: 6.2% of patients 2

This study demonstrated that compared to clozapine, the risk of nocturnal enuresis was significantly lower in patients taking quetiapine (OR = 0.33,95% CI 0.13-0.59), but still present in approximately 1 in 15 patients 2.

Mechanism of Action

The mechanism by which quetiapine causes nocturnal enuresis is not fully understood but may relate to:

1. Anticholinergic effects affecting bladder function
2. Sedative properties causing deeper sleep and reduced arousal to bladder signals
3. Potential effects on antidiuretic hormone secretion

Management Options for Medication-Induced Enuresis

If a patient develops nocturnal enuresis while taking quetiapine, consider these approaches:

1. Dose adjustment: Consider lowering the dose if clinically appropriate
2. Timing modification: Administer the medication earlier in the evening rather than right before bedtime
3. Fluid restriction: Limit fluid intake in the evening hours
4. Scheduled voiding: Implement scheduled bathroom trips before bedtime
5. Medication change: Consider switching to an alternative antipsychotic with lower enuresis risk if clinically appropriate

Special Considerations

• Monitoring: Patients starting quetiapine should be informed about this potential side effect and monitored, particularly those with risk factors for enuresis
• Differential diagnosis: Rule out other causes of new-onset enuresis, including urinary tract infections, diabetes, and other medical conditions
• Documentation: Document the temporal relationship between quetiapine initiation and onset of enuresis to establish causality

Clinical Pitfalls to Avoid

• Underrecognition: Nocturnal enuresis may be underreported due to patient embarrassment
• Misattribution: Don't automatically attribute new-onset enuresis to psychological factors without considering medication effects
• Inappropriate management: Avoid treating medication-induced enuresis with additional medications (like anticholinergics) without first considering dose adjustment or medication change
• Ignoring impact: Don't underestimate the negative impact of enuresis on quality of life and medication adherence

While quetiapine is an effective antipsychotic with a relatively benign side effect profile compared to older agents 3, nocturnal enuresis is a documented adverse effect that clinicians should be aware of when prescribing this medication.