Clomipramine Urinary retention

After treatment with clomipramine for an obsessive-compulsive disorder, a 15-year-Old boy had 2 episodes of acute urinary retention, Initially clomipramine was given in gradual Increments to reach a dose of 150 mg/day In the first few days the patient suffered from dry mouth, drowsiness, Increased sweating and anorexia Improvement of obsesslve­compulsive symptoms occurred by 3 weeks but the patient reported marked urinary hesitation, urinary dribbling, reduced flow, and then noctUria, Urological examination was normal Two doses of subcutaneous bethanechol chlOride 5mg were given With no Improvement, Increasing doses of oral phenoxybenzamlne up to 40 mg/day for 3 days also failed to relieve urinary symptoms

Clomipramine treatment continued With further improvement of obsessive­compulSive symptoms, At week 10 the dose was reduced to 75 mg/day, Urinary symptoms abated but obseSSive thoughts and compulsions returned, The dose was doubled with partial improvement of obsessive­compulsive symptoms but recurrence of urinary symptoms, Clomipramine dose was increased to 200 mg/day resulting in almost complete disappearance of psychiatriC symptoms but at week 20 the patient had a 16-hour episode of urinary retention He was catheterised and clomipramine was withdrawn, All the Original manifestations of his obseSSive-compulsive disorder reappeared

Although the anticholinergic effects of tricyclic anlldepressants are frequent, especially in older patients, some degree of tolerance usually develops, Alternative treatment such as behaviour therapy should be considered in those patients with obsessive-compulsive disorders who suffer serious clomipramine-induced urinary adverse effects,

Hermesh H, Aizenberg D Weizman A, Lapidot M, Munitz H Drug Intelligence and Clinical Pharmacy 21 877-879, Nov 1987

0157-7271/87/1205-0007/0$01.00/0 © ADIS Press REACTIONS~ 5 December 1987 7