Abstract
Introduction: Urinary incontinence or nocturnal enuresis is an infrequently reported side effect of Olanzapine. In this case report, we present a patient with nocturnal enuresis induced by Olanzapine with a complete lack of response to dose reduction or Oxybutynin treatment. Complete resolution of symptoms was ultimately achieved through switching Olanzapine to Clozapine and using combination therapy with Desmopressin and Oxybutynin.
Case Description: A 24-year-old Caucasian male, with a past medical history of attention deficit hyperactivity disorder (ADHD), schizoaffective disorder: depressive type, and substance use disorder, was referred for the current treatment program. At his current treatment program, the patient was started on Olanzapine, Gabapentin, and Venlafaxine. The patient reported Olanzapine-induced sedation which was treated with the addition of Modafinil and Adderall. The Olanzapine dose was decreased and then the patient voluntarily reported enuresis for the first time. He reportedly noticed it for a few weeks but was too embarrassed to mention it. He described sleeping through the night and realizing he had wet the bed upon waking up in the morning after 7- 8 hours of continuous sleep. The patient reported no other urinary tract symptoms including no loss of bladder control during the day. He was immediately started on Oxybutynin due to the enuresis. The patient denied any improvement in incontinence and continued to have two additional episodes of nocturnal enuresis. Urinalysis was performed and was negative for bacteria therefore the diagnosis of a urinary tract infection was unlikely. Olanzapine was discontinued and switched to Clozapine due to persistent nocturnal enuresis. Despite the continuation of oxybutynin, the patient continued having symptoms of nocturnal enuresis, leading us to add Desmopressin to his treatment regimen. The patient reported that he did not have any episodes of bed-wetting after Desmopressin was added and Olanzapine was stopped. The enuresis did not resolve as expected with oxybutynin while taking olanzapine, but we were unable to continue the trial due to the need to switch to clozapine.
Discussion: The case illustrates the multifactorial and patient-specific nature of nocturnal enuresis induced by second-generation antipsychotics.
