The Weekly Mind Reader: Urinary Retention As a Clozapine Side Effect

by Staff Writer
September 8, 2023 at 10:05 AM UTC

PCC has published new research that examines the relationship between psilocybin and brain chemicals such as serotonin and dopamine.

In the realm of psychiatric pharmacotherapy, understanding the potential adverse effects of medications is crucial for ensuring optimal patient care. Clozapine, an atypical antipsychotic known for its efficacy in treating treatment-resistant schizophrenia, has recently been associated with urinary retention. A new case study in The Primary Care Companion for CNS Disorders explored the clinical implications of this rare yet significant side effect. 

Understanding the Case

The case described a 65-year-old male patient with a complex psychiatric history. Despite previous treatment attempts with risperidone, the patient exhibited persistent agitation, aggressive behavior, and visual hallucinations. Consequently, his care team made the decision to initiate clozapine. However, soon after starting treatment, the patient experienced urinary complications, including decreased urinary output, lower abdominal pain, and worsening retention. Timely intervention and medication adjustments led to the resolution of these symptoms.

Why did this happen? 

Clozapine exerts its therapeutic effects through various pharmacological mechanisms. However, its potent anticholinergic activity can inadvertently lead to urinary retention and subsequent incontinence. Furthermore, the drug’s antiadrenergic properties may affect bladder sphincter tone, impairing the bladder’s ability to empty. The dopamine antagonist activity of clozapine can contribute to an overactive bladder, further exacerbating urinary retention as well. 

Clozapine also causes constipation which increases the risk of urinary woes and often leads to abdominal pain. It’s also worth noting that patients with drug-induced diabetes may be susceptible to polyuria, compounding urinary retention problems.

The case report underscores the significance of recognizing and managing urinary retention as a potential adverse effect of clozapine therapy. Clinicians should remain vigilant in monitoring patients for symptoms. A comprehensive evaluation, including physical assessment and the application of the Adverse Drug Reaction Probability Scale, can aid in determining the likelihood of clozapine-induced urinary retention.

In terms of treatment, dose reduction may be a viable strategy. The case demonstrated that lowering the clozapine dose led to an improvement in urinary retention within a few days. Additionally, adjunctive medications, such as tamsulosin for urinary retention and valproate/topiramate for mood stabilization, may prove beneficial in managing the overall well-being of patients.

Clozapine holds immense therapeutic value for treatment-resistant schizophrenia. However, it’s crucial to be on the lookout for urinary retention as a potential side effect, uncommon as it may be. This case study serves as a reminder of the importance of careful monitoring, timely intervention, and dose adjustments when working with patients receiving clozapine therapy. 

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

  • Aripiprazole 2-month ready-to-use 960 mg, or Ari 2MRTU 960 for short, is a new long-acting injectable antipsychotic formulation that is administered every two months. A clinical trial found that it was well tolerated in clinically stable patients with schizophrenia, with efficacy similar to other treatments.
  • In a new examination, youth with bipolar disorder who did not have a history of self-harm demonstrated greater self-control and lower risk-taking behavior compared to both youth with bipolar disorder who had a history of self-harm and a control group.
  • Two new cases covering COVID published this week. One looked at the ethical challenges of managing acute mania in patients with the virus. The other assessed perceived stress associated with the pandemic in patients with neuro-Behçet’s disease.
  • Humans and large language artificial intelligence models like ChatGPT may seem like strange bedfellows in mental health, but one researcher is using AI to teach clinicians how to express empathy with their clients more effectively.
  • Follow our Youtube channel for insightful psychiatry and neurology videos. This one features Leslie Citrome, MD discussing emerging treatment approaches for schizophrenia that show promise.

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Original Research

Safety and Tolerability of Starting Aripiprazole Lauroxil With Aripiprazole Lauroxil NanoCrystal Dispersion in 1 Day Followed by Aripiprazole Lauroxil Every 2 Months Using Paliperidone Palmitate Monthly as an Active Control in Patients With Schizophrenia: A Post Hoc Analysis of a Randomized Controlled Trial

In this post hoc analysis, treatment of acutely exacerbated schizophrenia with aripiprazole lauroxil or paliperidone palmitate was well tolerated, consistent with the safety profiles of these medications.

Leslie Citrome and others

Notice of Retraction

Notice of retraction for a letter to the editor.