Which one of the serotonin uptake inhibitors (SSRIs) is least likely to cause urinary retention?/nA

Fråga: Which one of the serotonin uptake inhibitors (SSRIs) is least likely to cause urinary retention?

A 38-year-old man is treated with sertraline (Zoloft) due to obsessive compulsive disorder. He sometimes has urinary retention. Is there any other SSRI drug that is less likely to cause this problem?

Sammanfattning: All of the SSRI drugs and clomipramine may cause urinary retention as an adverse effect. Clomipramine is more likely than SSRI drugs to cause this adverse reaction. It is not possible to determine which one of the SSRI drugs is least likely to cause urinary retention. Instead of sertraline maybe fluoxetine would be a good choice.

Svar: There exist five different SSRI drugs: citalopram (Cipramil), paroxetine (Seroxat), fluvoxamine (Fevarin), fluoxetine (Fontex) and sertraline (Zoloft). Clomipramine (Anafranil), a tricyclic antidepressive, is also used in obsessive compulsive disorder. It is fairly common (> 1/100 patients) that citalopram, paroxetine and clomipramine cause mictation disturbances according to FASS (1). According to the same source fluvoxamine and fluoxetine can also cause this adverse reaction, but not as frequent, and for sertraline this adverse reaction is not registered. There exist reports in SWEDIS (Swedish Drug Information System) of urinary retention with all of these drugs. A search in pharmacology handbooks and Drugline gave that anticholinergic adverse effects are more common for clomipramine than SSRI drugs (2-6). Urinary retention is probably caused by an anticholinergic mechanism of these medications. No further clues of which one of the SSRI drugs is least likely to cause this problem was found. It is recommended that another SSRI drug (that has obsessive compulsive disorder as an indication) is tried, such as fluoxetine (7).

We recommend this case be reported to SADRAC (Swedish Adverse Drug Reactions Advisory Committee). 1 FASS 1998 (The Swedish catalogue of approved medical products) 2 Speight TM, Holford NHG, editors. Avery´s Drug treatment. 4th ed. Auckland: Adis; 1997 3 American Medical Association, Drug evaluations. Annual 1995 4 Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Goodman Gilman A, editors. Goodman & Gilman´s The pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill; 1996 5 Rudorfer MV, Manji HK, Potter WZ: Comparative tolerability profiles of the newer versus older antidepressants. Drug Safety 1994; 10: 18-37 6 Drugline no 13064 (year 1997) 7 Discussion with Dr Christer Allgulander, Psychiatric Department, Huddinge hospital, Sweden