Can clonidine or risperidone cause nocturnal enuresis (bedwetting)?

Risperidone and Clonidine Can Both Cause Bedwetting

Yes, both risperidone and clonidine can cause nocturnal enuresis (bedwetting), with risperidone having a higher documented incidence of approximately 6-10% compared to clonidine. 1, 2

Risperidone and Bedwetting

• Risperidone has been clearly documented to cause enuresis as a side effect, with the FDA label specifically listing enuresis as occurring in 10% of pediatric patients with autism spectrum disorders 1
• A comparative cohort study found that approximately 6.2% of patients taking risperidone experienced nocturnal enuresis 2
• While this rate is lower than with clozapine (20.7%), it is still a significant side effect that patients and caregivers should be aware of 2
• Case reports have documented risperidone-induced nocturnal enuresis that required specific treatment interventions 3

Clonidine and Bedwetting

• Interestingly, clonidine has a paradoxical relationship with bedwetting:
  • It can cause enuresis as a side effect in some patients due to its central nervous system effects 4, 5
  • However, it has also been studied as a potential treatment for refractory nocturnal enuresis in children who don't respond to first-line treatments 6
• A study of children with refractory enuresis found that adding clonidine (4 μg/kg/day) actually improved bedwetting in 56.1% of patients 6

Mechanism of Action Related to Enuresis

• Risperidone's effect on bedwetting may be related to:
  • Its alpha-adrenergic antagonist properties which can affect bladder function 2
  • Sedative effects that may decrease arousal to bladder fullness signals during sleep 1
• Clonidine's effects may be related to:
  • Its central alpha-2 agonist activity that suppresses sympathetic nervous system outflow 4, 5
  • Potential effects on sleep architecture that might impact arousal to bladder signals 4

Clinical Implications

• For patients starting risperidone:
  • Monitor for development of nocturnal enuresis, particularly in pediatric populations 1
  • Consider that the risk is higher than with some other atypical antipsychotics like quetiapine (6.7%) 2
• For patients on clonidine:
  • Be aware of the potential for enuresis as a side effect, though it appears less common than with risperidone 4, 5
  • In some cases of pre-existing enuresis, clonidine might actually improve the condition 6

Management Options for Medication-Induced Enuresis

• If enuresis develops:
  • Consider dose reduction if clinically appropriate 3
  • Evaluate timing of medication administration (earlier evening dosing may help) 1
  • Limit evening fluid intake without causing dehydration 7
  • For severe cases that require continued medication use, additional pharmacological interventions may be considered 3

Monitoring and Prevention

• Establish baseline continence status before starting either medication 7
• Directly ask patients or caregivers about bedwetting during follow-up visits, as they may be reluctant to report this embarrassing side effect 2
• Consider the impact of enuresis on quality of life and medication adherence, especially in children and adolescents 7

In conclusion, both medications can cause bedwetting, with risperidone having more robust documentation of this side effect. The decision to continue or change medication should balance the therapeutic benefit against the impact of enuresis on the patient's quality of life.