Can clozapine cause problems with urine or urination, such as incontinence or enuresis?

Urinary incontinence (enuresis) has been reported in between 1% and 20% of patients taking clozapine. It usually occurs at night during the first three months of treatment. A number of mechanisms have been proposed, including sedation or α-adrenergic blockade. Initial management options include limiting fluid intake during the evening, voiding at bedtime, and scheduling a middle-of-the-night awakening to empty the bladder. Enuresis alarms can also be used. There is limited research or consensus regarding pharmacological approaches to management of this side effect. There is some evidence supporting desmopressin, oxybutynin, and pseudoephedrine. Serum sodium should be assessed if using desmopressin. The use of a second antipsychotic medication increases the risk for enuresis, so there should be consideration of tapering off non-clozapine antipsychotic medications.  Another potential side effect of clozapine is urinary retention, though this is extremely rare. Urinary retention can present as lessening of urinary output, bladder sensations, abnormal urinary flow, straining to void, and discomfort or pain. Other potential causes of urinary retention should be considered, including neurological conditions, diabetes, prostatic hypertrophy, other medications, and obstructions. If urinary retention is suspected, the patient should be promptly evaluated and treated.

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