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arznei-telegramm 2011; 42: 80

 


E.g. clozapine (LEPONEX, generics): bedwetting with atypical antipsychotics in adults

Bedwetting can be an unpleasant and embarrassing result of taking atypical antipsychotics and can negatively affect the patient's adherence to treatment. Results from an observational study of a working group from the New Zealand pharmacovigilance program IMMP* suggest that this complication appears to be common to very common (1). In a questionnaire, 41 of 606 patients (including 6 on two different drugs) indicated that bedwetting had newly occurred: When taking clozapine (LEPONEX, generics) 20.7% (17 of 82 patients), olanzapine (ZYPREXA) 9.6% (11 of 115), quetiapine (SEROQUEL) 6.7% (7 of 105) and risperidone (RISPERDAL, generics) 6.2% (12 of 195).

Information on bedwetting is missing in the German Summaries of Product Characteristics (SPC). However, enuresis is listed as a common disturbing side effect of risperidone (2); in the SPCs for other atypical antipsychotics, only urinary incontinence is mentioned and classified as common with clozapine (3,4), as uncommon with olanzapine (5) and risperidone (2) and as rare with quetiapine (6). "It is not to be expected (…) that especially the reporting patients differentiate between the various forms of incontinence in their reports", stated the olanzapin manufacturer Lilly to explain the lack of reference to bedwetting (7). But even if bedwetting is attributed to urinary incontinence, the frequencies with which this side effect is mentioned in the SPCs seems to be too low, given the observational study.

It is appropriate to directly ask patients taking atypical antipsychotics whether they have experienced bedwetting in connection with the treatment. Treatment strategies could include fluid restriction in the evenings, dose reduction, or switching to a different drug. When using conventional antipsychotics, enuresis and urinary incontinence are apparently reported more rarely. However, we found no study targeted to this question, -Red.

 

1

HARRISON-WOOLRYCH, M. et al.: Br. J. Psychiatry 2011; 199: 140-4

 

2

Janssen-Cilag: SPC RISPERDAL, as at March 2011

 

3

Novartis: SPC LEPONEX, as at Apr. 2010

 

4

Pfizer: SPC ELCRIT, as at Jan. 2010

 

5

Lilly: SPC ZYPREXA, as at Nov. 2010

 

6

AstraZeneca: SPC SEROQUEL, as at Apr. 2011

 

7

Lilly: Letter, dated 23. August 2011

 

*

IMMP = Intensive Medicines Monitoring Programme



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