Abstract:

Risperidone is an atypical antipsychotic agent, widely used in the management of anger, aggression, and behavioral problems in children and adolescents. Its use in children and adolescents is safe, and the most frequently reported side-effects are weight gain, listlessness, and increased appetite. Enuresis is a rare complication following risperidone use. This report describes two pediatric cases of enuresis developing following a risperidone use. The first case was a 9-year-old boy diagnosed with attention-deficit/ hyperactivity disorder with combined presentation and oppositional defiant disorder. Diurnal and nocturnal enuresis began on the fifth day of 0.5 mg risperidone therapy and resolved four days after discontinuation of risperidone. The second patient was a 13-year-old boy diagnosed with Down syndrome, intellectual disability, and conduct disorder. Diurnal and nocturnal enuresis started on the third day of 1 mg/day risperidone therapy and resolved 10 days after discontinuation of risperidone. Both patients were subsequently started on aripiprazole, with a low α-1 adrenergic blocking effect, and no enuresis occurred during their follow-up visits. Cases of both nocturnal and diurnal enuresis following risperidone use are rare in the previous literature. In addition to the central dopamine blocking caused by antipsychotics, mechanisms such as peripheral α-blockage involvement in relaxation of the urethral muscles and blocking of the pudendal muscles with 5-HT2 and 5-HT3 antagonism have also been implicated in urinary incontinence. This report is important in terms of emphasizing the rare side-effect of both nocturnal and diurnal enuresis following a risperidone use. Considering also the adverse impact of urinary incontinence of patients’ quality of life, it is important for clinicians to be aware of such a side-effect in order to increase compliance with treatment in patients.

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