Trihexyphenidyl (benzhexol) in clozapine-induced nocturnal enuresis and sialorrhea

Aggarwal, Ashish; Garg, Amit; Jiloha, RC

doi:10.4103/0019-5359.57642

Cited by 12 publications

(30 citation statements)

References 7 publications

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“…Four patients (5%) had urinary incontinence prior to commencing clozapine. Other reported clozapine-induced adverse events included sialorrhea (eight patients), 26,[30][31][32][33][34][35] sedation (three patients), 26,33,34 constipation (two patients), 32,34 weight gain (two patients), 32,33 tremor (one patient), 32 worsening OCD symptoms (one patient), 32 diaphoresis (one patient), 32 tachycardia (one patient), 33 and overeating (one patient). 33 Table 1 provides a summary of the results and safety considerations.…”

Section: Resultsmentioning

confidence: 99%

Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

et al. 2022

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Background Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug reactions, including nocturnal enuresis and urinary incontinence. This side effect can be burdensome and lead to medication nonadherence and psychotic relapse. Evidence to guide treatment of clozapine-induced nocturnal enuresis and urinary incontinence is sparse. We therefore aimed to synthesize the evidence base to guide management for clinicians, patients, and their carers. Methods We systematically searched PubMed, Embase, PsycInfo, CINAHL, and the Cochrane Trial Registry databases from inception to May 2021 for publications on management of clozapine-induced nocturnal enuresis and urinary incontinence using a PROSPERO preregistered search strategy. Results We identified 22 case reports and case series describing 74 patients. Interventions included clozapine dose reduction, nonpharmacological treatment, and pharmacological treatments. Among pharmacological treatments, desmopressin, oxybutynin, trihexyphenidyl, tolterodine, imipramine, amitriptyline, ephedrine, pseudoephedrine, aripiprazole, and verapamil were associated with complete resolution of nocturnal enuresis and urinary incontinence. Balancing evidence for effectiveness against risk of adverse effects, we developed a management framework for clozapine-induced nocturnal enuresis and urinary incontinence. Conclusions Following assessment of urological, psychiatric, pharmacological, and common comorbid medical issues, first-line treatments should be nonpharmacological, including bathroom alarms, voiding before bedtime, and nocturnal fluid restriction. If these interventions do not provide adequate relief, aripiprazole should be trialed. Desmopressin may be considered for severe refractory cases, but monitoring for hyponatremia is essential.

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Section: Resultsmentioning

confidence: 99%

Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

et al. 2022

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“…After review of the literature, it appears that pharmacological treatment of psychiatric medication-induced enuresis has rarely been attempted except in the context of patients with psychiatric conditions well-controlled with atypical antipsychotics. Trihexyphenidyl, an M1 antagonist, has been effective in treatment of both clozapineinduced enuresis and sialorrhea [14]. Aripiprazole has been used to treat clozapine-induced enuresis, possibly due to D2 agonist activity in the clozapine-induced hypodopaminergic state within the basal ganglia [15].…”

Section: Discussionmentioning

confidence: 99%

Risperidone-associated enuresis—a case report

Sarangi

Mkhantar

Weaver

2021

Middle East Curr Psychiatry

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Background Risperidone has been reported to be effective in treating both the positive and negative symptoms of schizophrenia, aggression, and behavioral disorders. While the metabolic side effect profile of this medication has been broadly studied, studies related to this medication’s bladder effects are relatively rare. We present a case of risperidone-induced enuresis in an adult male with schizophrenia that resolved upon discontinuation of the offending medication. Case presentation We describe a case of a 32-year-old man with a primary psychotic disorder who developed debilitating enuresis secondary to taking risperidone. Enuresis resolved upon switching to Seroquel. Conclusion Enuresis secondary to risperidone is not commonly discussed prior to initiation by the treating psychiatrist however can be debilitating. Discussing this potential side effect is critical to informed decision making on the patient’s part.

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“…Pharmacological management should be considered if there is a risk of cessation of the antipsychotic medicine or any decline in patient compliance; the pharmacological agents may include amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl. 31 , 38 – 40) Some anticholinergic agents are regularly used to ease the urgency of urinary incontinence in clinical practice. In our case, we observed a substantial benefit after using the anticholinergic agent solifenacin, which is a competitive inhibitor of muscarinic M3 receptor.…”

Section: Discussionmentioning

confidence: 99%

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

Karslıoğlu

Özalp

Çayköylü

2016

Clin Psychopharmacol Neurosci

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Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients’ compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

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Trihexyphenidyl (benzhexol) in clozapine-induced nocturnal enuresis and sialorrhea

Cited by 12 publications

References 7 publications

Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

Treatment strategies for clozapine-induced nocturnal enuresis and urinary incontinence: a systematic review

Risperidone-associated enuresis—a case report

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

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