Pseudoephedrine for Clozapine Incontinence

A 58-year-old man with psychosis had been unsuccessfully treated with multiple trials of conventional and atypical antipsychotics, antidepressants, mood stabilizers, and anxiolytics.1 His psychiatric status remained unstable, and he was hospitalized and started on clozapine (Clozaril). Results of laboratory analyses (e.g., white blood cells, absolute neutrophil counts) remained within normal limits after clozapine initiation, and his psychotic symptoms improved. However, soon after starting clozapine, the patient became incontinent. Because ephedrine had previously been associated with resolution of clozapine-induced incontinence, the patient was started on 30 mg pseudoephedrine 4 times per day. Within 3 days, the incontinence resolved and did not recur over >1 month of inpatient follow-up.