Urinary Retention due to Medications

Aka: Urinary Retention due to Medications, Medication Causes of Urinary Retention

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II. Pathophysiology

  1. Anticholinergic Medications
    1. Block parasympathetic muscarinic receptors in detrusor Muscle with impaired contractility
  2. Alpha-adrenergic agonists (e.g. Decongestants)
    1. Increases Prostate and Bladder neck
  3. Calcium Channel Blockers
    1. Decreased bladder Smooth Muscle contractility
  4. NSAIDs
    1. Inhibits prostaglandin synthesis and secondary decreased detrusor contractility (theoretical)

III. Causes: Common (esp. Anticholinergics)

  1. First Generation Antihistamine (e.g. Diphenhydramine, Bromopheniramine, Cyproheptadine, Hydroxyzine)
  2. Benzodiazepines
  3. Tricyclic Antidepressants
  4. Oral Decongestants
  5. NSAIDS

IV. Causes: Neuropsychiatric agents

  1. Amphetamines
  2. Benzodiazepines
  3. Carbamazepine
  4. Antiparkinson agents
    1. Amantadine
    2. Trihexyphenidyl
    3. Benztropine
    4. Levodopa
    5. Bromocriptine
  5. Tricyclic Antidepressants
    1. Amitriptyline
    2. Nortriptyline
    3. Imipramine
    4. Doxepin
  6. Antipsychotics
    1. Thioridazine
    2. Haloperidol
    3. Chlorpromazine
    4. Fluphenazine
    5. Prochlorperazine
    6. Thiothixene

V. Causes: Cardiopulmonary agents

  1. Antiarrhythmics
    1. Disopyramide
    2. Procainamide
    3. Quinidine
  2. Antihypertensives
    1. Hydralazine
    2. Dihydropyridine Calcium Channel Blockers (Nifedipine)
  3. Sympathomimetics
    1. Alpha-adrenergic agents (oral Decongestants)
      1. Phenylephrine
      2. Pseudoephedrine
    2. Beta-adrenergic agents
      1. Isoproterenol
      2. Terbutaline

VI. Causes: Miscellaneous

  1. Narcotic Analgesics
  2. Alcohol
  3. NSAIDs
    1. Verhamme (2005) Arch Intern Med 165:1547-51 [PubMed]
  4. Vincristine
  5. Skeletal Muscle Relaxants
    1. Baclofen
    2. Cyclobenzaprine
  6. Antispasmodic Gastrointestinal and Genitourinary medications
    1. Dicyclomine
    2. Glycopyrrolate
    3. Oxybutynin
    4. Scopolamine
  7. Antihistamines
    1. Diphenhydramine
    2. Hydroxyzine
    3. Chlorpheniramine

VII. Causes: Herbals and other over-the-counter products

  1. Ephedra or Ma Huang
  2. Country Mallow
  3. Heartleaf
  4. Bitter Orange

VIII. References

  1. Curtis (2001) Emerg Med Clin North Am 19:591-619 [PubMed]
  2. Drake (1998) Drug Saf 19:45-55 [PubMed]
  3. Guthrie (2004) Prescriber's Letter 20:1-4 [PubMed]
  4. Serlin (2018) Am Fam Physician 98(8): 496-503 [PubMed]

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