Switching to duloxetine remits ziprasidone - associated urinary incontinence and improves neuropsychiatric behavior in dementia: possible relationship of incontinence to 5HT2 receptor blockade.
OBJECTIVE
Urinary incontinence arising in dementia lowers patient quality of life, predicts caregiver burden and nursing home placement, and predisposes to adding additional medicines that can further impair cognition, behavior, and function. An understanding of incontinence pharmacology can help the clinician predict and manage this adverse event in treating patients with dementia.


METHODS
Case report.


RESULTS
We encountered a patient with Alzheimer's disease and vascular dementia who developed urinary incontinence and parkinsonism when ziprasidone was added to the regimen for behavioral concerns.When he was switched to duloxetine, the incontinence and parkinsonism resolved whereas improvements in perseveration, irritability, paranoia, and agitation persisted.


CONCLUSIONS
While a pharmacokinetic explanation is unlikely, the best evidence suggests that ziprasidone-mediated serotonin 5HT2 receptor blockade may explain the reversible incontinence, with an adrenergic alpha-1 receptor mechanism considered to be less likely. Patients on 5HT2 antagonist drugs, including atypical antipsychotics, should be observed for incontinence. In the event of incontinence developing in the context of these agents, duloxetine may represent a potential pharmacological alternative in some cases. Duloxetine may improve neuropsychiatric symptoms in dementia through its effects on serotonin, norepinephrine, and frontal dopamine.
Lauterbach
Edward C
EC
Department of Psychiatry & Behavioral Sciences, Mercer University School of Medicine, Macon, GA, USA. eclbgnp@earthlink.net
Baralatei
Florence T
FT
D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D015140:Dementia, Vascular / Q000188:drug therapy; D000068736:Duloxetine Hydrochloride; D006801:Humans; D008297:Male; D020734:Parkinsonian Disorders / Q000139:chemically induced; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D044348:Receptors, Serotonin, 5-HT2 / Q000187:drug effects* / Q000378:metabolism; D012702:Serotonin Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use*; D014549:Urinary Incontinence / Q000139:chemically induced
D000068736:Duloxetine Hydrochloride; D010879:Piperazines; D044348:Receptors, Serotonin, 5-HT2; D012702:Serotonin Antagonists; D017367:Selective Serotonin Reuptake Inhibitors; D013844:Thiazoles; D013876:Thiophenes; C092292:ziprasidone