title: Failure of tolterodine to treat clozapine-induced nocturnal enuresis.
abstract: OBJECTIVE
  To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness.
  
  
  METHODS
  A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. Clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms.
  
  
  CONCLUSIONS
  This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence.
  
  
  CONCLUSIONS
  Nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction.
authors.affiliation: Veterans Affairs Medical Center, Tuscaloosa, AL, USA. brett.english@med.va.gov
authors.forename: B A
authors.initials: BA
authors.lastname: English
authors.forename: D J
authors.initials: DJ
authors.lastname: Still
authors.forename: J
authors.initials: J
authors.lastname: Harper
authors.forename: S R
authors.initials: SR
authors.lastname: Saklad
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects*; D003408:Cresols / Q000627:therapeutic use*; D004775:Enuresis / Q000139:chemically induced* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010665:Phenylpropanolamine; D011618:Psychotic Disorders / Q000188:drug therapy; D000068737:Tolterodine Tartrate; D017211:Treatment Failure
chemical_list: D014150:Antipsychotic Agents; D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D003024:Clozapine