<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_gp-2018-0007_s_007_w2aab3b7ab1b6b1aab1c16b1Aa"><h3>Objectives</h3><p>Clozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective pharmacology, it has a broad range of side effects. Nocturnal enuresis secondary to the use of clozapine has been documented in the literature but may be overlooked, the link between drug and symptom being clinically unnoticed. Patients may not mention urinary symptoms due to supervening psychosis, co-existing symptomatology, embarrassment or shame. By raising awareness of the phenomenon, early recognition and patient support may improve compliance with clozapine medication, and consecutively, overall mental health. Consequently, this systematic review investigates the prevalence of nocturnal enuresis secondary to clozapine use.</p></sec><sec id="j_gp-2018-0007_s_008_w2aab3b7ab1b6b1aab1c16b2Aa"><h3>Methods</h3><p>A literature search on clozapine and nocturnal enuresis was used to identify the relevant papers. Papers providing the prevalence data on Clozapine associated nocturnal enuresis were selected for data extraction.</p></sec><sec id="j_gp-2018-0007_s_009_w2aab3b7ab1b6b1aab1c16b3Aa"><h3>Results</h3><p>47 papers were initially identified. Eight papers focused on the prevalence of clozapine associated nocturnal enuresis (CANE). Point prevalence (nocturnal enuresis at the time of assessment), 1-month prevalence and episode prevalence (nocturnal enuresis since beginning of clozapine) were given. Papers included patients with schizophrenia, schizoaffective disorder, bipolar affective disorder and psychotic depression, taking clozapine medication. The prevalence of CANE ranged from 10–42%. Point prevalence was 21–27%, 1-month prevalence was 10–39% and episode prevalence was 15–42%. Clozapine was more likely to cause nocturnal enuresis compared to other psychotropic medication.</p></sec><sec id="j_gp-2018-0007_s_010_w2aab3b7ab1b6b1aab1c16b4Aa"><h3>Conclusion</h3><p>The prevalence of CANE may be greater than previously thought. However, in order to determine an accurate prevalence of clozapine associated nocturnal enuresis, larger studies with strict inclusion criteria, common definition of diagnosis and prevalence are required. By establishing an accurate prevalence, physician awareness can be improved, and patients can becounselled on the risk of developing the side effect, thus improving early identification and reducing discontinuation rates.</p></sec></abstract>

ObjectivesClozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective pharmacology, it has a broad range of side effects. Nocturnal enuresis secondary to the use of clozapine has been documented in the literature but may be overlooked, the link between drug and symptom being clinically unnoticed. Patients may not mention urinary symptoms due to supervening psychosis, co-existing symptomatology, embarrassment or shame. By raising awareness of the phenomenon, early recognition and patient support may improve compliance with clozapine medication, and consecutively, overall mental health. Consequently, this systematic review investigates the prevalence of nocturnal enuresis secondary to clozapine use.MethodsA literature search on clozapine and nocturnal enuresis was used to identify the relevant papers. Papers providing the prevalence data on Clozapine associated nocturnal enuresis were selected for data extraction.Results47 papers were initially identified. Eight papers focused on the prevalence of clozapine associated nocturnal enuresis (CANE). Point prevalence (nocturnal enuresis at the time of assessment), 1-month prevalence and episode prevalence (nocturnal enuresis since beginning of clozapine) were given. Papers included patients with schizophrenia, schizoaffective disorder, bipolar affective disorder and psychotic depression, taking clozapine medication. The prevalence of CANE ranged from 10–42%. Point prevalence was 21–27%, 1-month prevalence was 10–39% and episode prevalence was 15–42%. Clozapine was more likely to cause nocturnal enuresis compared to other psychotropic medication.ConclusionThe prevalence of CANE may be greater than previously thought. However, in order to determine an accurate prevalence of clozapine associated nocturnal enuresis, larger studies with strict inclusion criteria, common definition of diagnosis and prevalence are required. By establishing an accurate prevalence, physician awareness can be improved, and patients can becounselled on the risk of developing the side effect, thus improving early identification and reducing discontinuation rates.

Nocturnal Enuresis is an Under-recognised Side Effect of Clozapine: Results of a Systematic Review

Global Psychiatry

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

ObjectivesClozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective...

Nocturnal Enuresis is an Under-recognised Side Effect of Clozapine: Results of a Systematic Review

Published Online: Nov 12, 2018

Page range: 21 - 30

Received: Aug 28, 2018

Accepted: Aug 28, 2018

DOI: https://doi.org/10.2478/gp-2018-0007

Keywords
Clozapine, schizophrenia, nocturnal enuresis, urinary incontinence, antipsychotic, systematic review, side effect

© 2019 Niku Dhillon, Reinhard Heun. published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Nocturnal Enuresis is an Under-recognised Side Effect of Clozapine: Results of a Systematic Review

Published Online: Nov 12, 2018

Page range: 21 - 30

Received: Aug 28, 2018

Accepted: Aug 28, 2018

DOI: https://doi.org/10.2478/gp-2018-0007

KeywordsClozapine, schizophrenia, nocturnal enuresis, urinary incontinence, antipsychotic, systematic review, side effect

© 2019 Niku Dhillon, Reinhard Heun. published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
Clozapine, schizophrenia, nocturnal enuresis, urinary incontinence, antipsychotic, systematic review, side effect