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13 - Managing Enuresis and Incontinence, Priapism, Venous Thromboembolism, Neuroleptic Malignant Syndrome, Tardive Dyskinesia and Obsessive Compulsive Disorder

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer  and
Stephen M. Stahl
Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Along with metabolic problems, there are a number of other adverse effects not unique to clozapine, but which present unique treatment considerations given the absence of alternatives to clozapine for many patients. An important part of prescribing clozapine is developing patient rapport, and conveying the message that embarrassing adverse effects such as nocturnal enuresis and incontinence can occur in up to 40% of patients, and will be addressed, especially if persistent. Normalizing the experience through education and elucidation of a prior history of such problems is a helpful means of initiating the discussion, and imparting to patients that this is not an unusual issue, and that there are standard approaches to these problems. Nonetheless, direct inquiry is the best method for elucidating complaints about enuresis or incontinence. Large studies of clozapine treatment discontinuation often cite “patient preference” when no specific reason is provided. Given the high prevalence of enuresis early in treatment, and the fact that it may persist in 20% of patients, the absence of this complaint from the literature on clozapine discontinuation suggests a lack of communication with providers.

Type
Chapter
Information
The Clozapine Handbook
Stahl's Handbooks
 , pp. 242 - 257
Publisher: Cambridge University Press
Print publication year: 2019

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