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pharmaceutical causes of urinary incontinence
Etiology:
1) pharmaceuticals with anticholinergic effects
a) potential effects on continence
- urinary retention
- overflow incontinence
- delirium
- impactation
b) examples
- antihistamines
- diphenhydramine
- hydroxyzine
- tricyclic antidepressants
- amitriptyline
- desipramine
- antipsychotics
- thioridazine
- haloperidol
- anti-parkinsonian agents
- trihexyphenidyl
- benztropine mesylate
- dicyclomine
2) parasympathomimetics
a) potential effects on continence
- detrusor instability
- urge incontinence
b) examples
- cholinesterase inhibitors
- nicotine
3) loop diuretics
a) potential effects on continence
- polyuria
- frequency
- urgency
b) examples
- furosemide (Lasix)
- bumetanide (Bumex)
4) sedative/hypnotics
a) potential effects on continence
- sedation
- delirium
- immobility
b) examples
- long-acting benzodiazepines (diazepam, flurazepam)
5) alcohol
- potential effects on continence
- polyuria
- frequency
- urgency
- sedation
- delirium
- immobility
6) caffeine -> worsening or precipitation of urge incontinence
7) opiates
- potential effects on continence
- urinary retention
- fecal impactation
- sedation
- delirium
8) alpha-adrenergic agonists (esp. in men with BPH*)
a) potential effects on continence
- urinary retention in men
b) examples
- sympathomimetics
- decongestants
9) alpha-adrenergic antagonists (women)
a) potential effects on continence
- urethral relaxation may precipitate stress incontinence in women
b) examples
- prazosin (Minipress)
- terazosin (Hytrin)
- doxazosin (Cardura)
10) beta-adrenergic receptor agonists -> urinary retention [3]
11) calcium channel blockers
a) potential effects on continence
- urinary retention
- nocturnal diuresis due to fluid retention
b) examples
- all dihydropyridines
- amlodipine, felodipine, isradipine, nimodipine, nifedipine, nicardipine, nisoldipine, nitrendipine
12) angiotensin-converting enzyme (ACE) inhibitors
a) potential effects on continence
- drug-induced cough can precipitate stress incontinence in women & some men with prior prostatectomy
- cough with relaxation of pelvic floor [3]
b) examples
- captopril
- enalapril
- lisinopril
13) thiazolidinedione (glitazone)
a) potential effects on continence
- edema resulting in nocturnal polyuria [3]
b) examples
- pioglitazone
- rosiglitazone
- triglitazone
14) NSAIDs: - edema resulting in nocturnal polyuria [3]
15) GABAergic agents
a) potential effects on continence
- edema resulting in nocturnal polyuria [3]
b) examples
- gabapentin
- pregaballn
16) estrogens worsen stress incontinence
17) chemotherapeutic agents
- vincristine may cause urinary retention
* Benign Prostatic Hypertrophy
Related
urinary incontinence (UI)
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 41
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Geriatrics at your Fingertips, 13th edition, 2011
Reuben DB et al (eds)
American Geriatric Society
- Erdem M & Chu FM
Management of overactive bladder and urge urinary incontinence
in the elderly patient.
Am J Med 2006;119(3A):295