Does paroxetine cause urinary retention? (+2 causes)
By
Dr Maryam Shabbir (PhD)
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
Author bio
Dr Maryam Shabbir PhD is a pharmacist with expertise in drugs delivery, pharmacology, dosage form design, transdermal drug delivery system, microneedles, and solubility enhancement. She writes and reviews content on these topics.
Dr Maryam Shabbir’s Highlights:
Assistant Professor at The University of Lahore, Lahore, Pakistan.
PhD in Pharmaceutics with a focus on solubility enhancement of BCS class II and III drugs and their delivery through transdermal route using microneedles.
Doctor of Pharmacy at the University of Lahore with a two-year scholarship.
Professional Experience:
Dr Maryam Shabbir joined Faculty of Pharmacy, The University of Lahore as soon as she completed her Pharm-D in 2010. In 2017, she got promoted as an assistant professor.
Dr Maryam Shabbir has supervised twenty two M.Phil. students in pharmaceutics in areas such as transdermal drug delivery system, nanoparticles, microparticle, solid dispersion, and transdermal patches.
Dr Maryam Shabbir has also contributed to several business consultancies and research projects, including the development of lyophilized wafer of Acyclovir with Medisearch Pharmacal Pvt. Ltd., a major pharmaceutical industry in Pakistan.She has also worked as a team member in one of the Contract Research Organizations of Pakistan.
Dr Maryam Shabbir has organized two International conferences and three national conferences as conference secretary for the University of Lahore in collaboration with Punjab Higher Education Commission of Pakistan.
Dr Maryam Shabbir has submitted two patents to the Intellectual Property Organization of Pakistan (IPO), and three patents are in pipeline. She has also presented her work in different exhibitions organized by the Higher Education Commission of Pakistan. She works in close liaison with the Innovation Hub, University of Lahore, Pakistan.
Dr Maryam Shabbir participated as a member of the examination board for several Master’s exams and as an external examiner for Pharm-D in reputable universities of Pakistan. She is also a member of Punjab Pharmacy Council and Pakistan Pharmacist Association.
Education:
2010 Pharm D at the University of Lahore, Lahore, Pakistan
2013 Master of Philosophy (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
2022 PhD (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
The main publications of Dr. Maryam Shabbir are:
Saeed S, Barkat K, Ashraf MU, Shabbir M, Anjum I, Badshah SF, et al. Flexible Topical Hydrogel Patch Loaded with Antimicrobial Drug for Accelerated Wound Healing. Gels. 2023;9(7):567.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, et al. Preparation and characterization of polymeric cross-linked hydrogel patch for topical delivery of gentamicin. e-Polymers. 2023;23(1):20230045.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, Mehmood Y, Khalid I, Malik NS, Bin Jardan YAl. Fabrication of pH responsive hydrogel blends of chondroitin sulfate/pluronic F-127 for the controlled release of ketorolac: its characterization and acute oral toxicity study. Drug Development and Industrial Pharmacy. 2022;48(11):611-22.
Maher S, Shabbir M, Anam I, Khan N, Iqbal S, Saleem F. Anti-inflammatory and anti-oxidant activities of methanolic extract of medicinal plants from Balochistan. Int J Biol Biotechnol. 2020;15:691-7.
Shabbir M, Sajid A, Hamid I, Sharif A, Akhtar MF, Raza M, et al. Influence of different formulation variables on the performance of transdermal drug delivery system containing tizanidine hydrochloride: in vitro and ex vivo evaluations. Brazilian Journal of Pharmaceutical Sciences. 2019;54:e00130.
Nagra U, Adnan S, Shafqat S, Shabbir M, Ali S, Zafar A, et al. Effect of Sustained Release Polymers on Drug Release Profile of Aceclofenac Tablets Physicochemical Properties, Analysis of Kinetics and Fit Factor. Indian J Pharm Educ Res. 2019;53:58-65.
Fatima S, Akhtar MF, Ashraf KM, Sharif A, Saleem A, Akhtar B, Peerzada S, Shabbir M, Ali S, Ashraf W, Antioxidant and alpha amylase inhibitory activities of Fumaria officinalis and its antidiabetic potential against alloxan induced diabetes. Cellular and molecular biology (Noisy-le-Grand, France). 2019;65(2):50-7.
Saeed S, Raza M, Shabbir M, Akhtar MF, Sharif A, Zaman M, et al. Study of Multi-Drug Resistance Associated with Anti-Tuberculosis Treatment by DOT Implementation Strategy in Pakistan. Journal of Basic & Applied Sciences. 2018;14:107-12.
Arshad I, Ali S, Amin U, Shabbir M, Raza M, Sharif A, et al. Effect of hydrophilic and hydrophobic polymer on the release of ketoprofen and allopurinol from bilayer matrix transdermal patch. Advances in Polymer Technology. 2018;37(8):3076-83.
Sohail K, Javaid Z, Hamid I, Sharif A, Akhtar MF, Raza M, Ali S, Shabbir M, Peerzada S, Ahmad S. Formulation and evaluation of ranitidine floating tablets using different polymer combinations. Journal of Toxicological &Pharmaceutical Sciences. 2017;1(1):18-25.
Sharif A, Akhtar MF, Akhtar B, Saleem A, Manan M, Shabbir M, et al. Genotoxic and cytotoxic potential of whole plant extracts of Kalanchoe laciniata by Ames and MTT assay. EXCLI journal. 2017;16:593.
Shahid N, Adnan S, Farooq M, Ali S, Shabbir M, Masood Z, et al. Development of compressed coated polypill with mucoadhesive core comprising of atorvastatin/clopidogrel/aspirin using compression coating technique. Acta Poloniae Pharmaceutica. 2017;74(2):477-87.
Shabbir M, Fazli AR, Ali S, Raza M, Sharif A, Akhtar MF, et al. Effect of hydrophilic and hydrophobic polymer on in vitro dissolution and permeation of bisoprolol fumarate through transdermal patch. Acta Pol Pharm. 2017;74:187-97.
Saba Mazhar NS, Raza M, Akhtar B, Zahra A, Akhtar MF, Saleem A, Chishti SA, Shabbir M, Sharif A. A descriptive study of Measles outbreak in Lahore, Pakistan in 2013. J Toxicol Pharmaceut Sci. 2017;1(1):26-30.
Manzoor I, Raza M, Shabbir M, Ali S, Akhtar MF, Peerzada S, et al. Formulation and characterization of curcumin nanoparticles prepared from eudragit L-100 and poly vinyl alcohol as polymer. J Toxicol Pharmaceut Sci. 2017;1(1):7-12.
Akhtar MF, Sharif A, Saleem M, Saleem A, Akhtar B, Raza M, Ijaz H, Shabbir M, Ali S, Nasim MB, Peerzada S. Genotoxic and cytotoxic potential of Alternanthera Bettzickiana, an important ethno-medicinal plant. Cellular and Molecular Biology. 2017;63(8):109-14.
Ahmed S, Saeed-Ul-Hassan S, Islam M, Qureshi F, Waheed I, Munawar I, Ishtiaq S, Rasool S, Akhtar MF, Chishti SA, Shabbir M. Anti-oxidant activity of Pistachia khinjuk supported by phytochemical investigation. Acta Pol Pharm. 2017;74(1):173-8.
Shahid N, Ali S, Shabbir M, Waqar K. Compressed coated polypill with mucoadhesive core for cardiovascular disease-A review. The Pharma Innovation. 2016;4(3, Part B).
Shabbir M, Ali S, Farooq M, Adnan S, Yousaf M, Idrees A, et al. Formulation factors affecting in vitro and ex vivo permeation of bisoprolol fumarate from a matrix transdermal patch. Advances in Polymer Technology. 2016;35(3):237-47.
Mehmood A, Hamid I, Sharif A, Akhtar MF, Akhtar B, Saleem A, Shabbir M, et al. Evaluation of anti-inflammatory, analgesic and antipyretic activities of aqueous and ethanolic extracts of seeds of Buchanania lanzan Spreng. In animal models. Acta poloniae pharmaceutica. 2016;73(6):1601-8.
Ali S, Shabbir M, Shahid N, Amin U, Hamid I, Raza M. Effect of Polysorbate 80 Through Rabbit’s Skin Using Transdermal Patch Loaded with Bisoprolol Fumarate as Model Drug. Pakistan J Zool. 2016;48(1):227-34.
Akhtar MF, Saleem A, Sharif A, Akhtar B, Nasim MB, Peerzada S, Raza M, Ijaz H, Ahmed S, Shabbir M, Ali S. Genotoxic and cytotoxic action potential of Terminalia citrina, a medicinal plant of ethnopharmacological significance. EXCLI journal. 2016;15:589.
Ali S, Shabbir M, Shahid N. The Structure of Skin and Transdermal Drug Delivery System-A Review. Research Journal of Pharmacy and Technology. 2015;8(2):103-9.
Shabbir M, Ali S, Shahid N, Rehman K, Amin U, Raza M. Formulation considerations and factors affecting transdermal drug delivery system-A review. International Journal of Pharmacy and Integrated Life Sciences. 2014;2(9):20-35.
Ali S, Shabbir M, Farooq M, Adnan S, Shahid N. The enhancement effect of permeation enhancers on Bisoprolol fumarate across animal membrane using Franz diffusion cell. Research Journal of Pharmacy and Technology. 2014;7(12):1391-5.
Conference papers
Shabbir M (2022), Sustainable Development Goals (SDGs): A Policy Gap between Health and Pharmaceutical Industry. In International Social Science Conference 2022 (School of International Social Sciences, University of Lahore).
Shabbir M (2022), Controlling Permeation of Ketoprofen and Allopurinol through Bilayer Transdermal Patch using Multiple Pharmaceutical Ingredients. In Current Advancement in Pharmacy Practice (CAPP)- Theory to Practice (University of Lahore, Lahore)
Shabbir M (2018), Nanocarriers Mediated Photodynamic Therapy for the Treatment of Different Cancers. In the 4th Annual International Pharmacy Scientific Symposium and Poster Exhibition-2018 (University of Central Punjab, Lahore).
Shabbir M (2018), Lipid Enveloped Polymeric Nanoparticles for Targeted Photodynamic Chemotherapy. In the 3rd International Health Trigon Summit-2018 (University of Lahore).
You can view some of Dr Maryam’s work below and links to her professional profile.
Publon Profile: publons.com/researcher/1495244/maryam-shabbir
ORCID: 0000-0002-9308-5175
Researchgate: https://www.researchgate.net/profile/Maryam-Shabbir-4
Google Scholar: Maryam Shabbir – Google Scholar
Linkedin Profile: https://www.linkedin.com/in/maryam-shabbir-b409a270
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss if paroxetine can cause urinary retention in the patient taking this medicine. We will also discuss other factors that can cause urinary retention. Paroxetine is a selective serotonin reuptake inhibitor (SSRI) that is used in the treatment of anxiety disorders.
Does paroxetine cause urinary retention?
Yes, paroxetine may cause urinary retention. However, the incidence of urinary retention due to paroxetine is uncommon as the drug does not have anticholinergic activity. The anticholinergic effect occurs due to a blockage in acetylcholine activity. Acetylcholine is involved in bladder contraction and urination.
It means that paroxetine might cause urinary retention due to changes in the serotonin level after administration. Paroxetine is an SSRI that increases the serotonin level and binds to the serotonin transporter with the highest known affinity (1).
Serotonin is a neurotransmitter that is involved in the central control system of urination. It promotes urine storage by activating the sympathetic reflex and blocking the parasympathetic route (1).
Urinary retention is characterised as the inability to pass urine due to a painful, palpable bladder. A bladder scan may be required to confirm acute urine retention (2). Immediately inform your doctor if you have difficulty urinating during treatment with paroxetine.
How does paroxetine cause urinary retention?
Several mechanisms explain the prevalence of urine retention with the use of paroxetine:
- The Onuf’s nucleus controls the external urethral sphincter tonus and is found in the S2-4 sacral section of the spinal cord. Onuf’s nucleus is densely packed with serotonin receptors. By blocking serotonin reuptake, paroxetine increases the external urethral sphincter activity (1).
- The spinal blockage of serotonin receptors lowers bladder contraction. Paroxetine promotes urine retention by desensitizing serotonin receptors and induces a reduction in bladder contraction (3).
What are the symptoms of paroxetine-induced urinary retention?
The symptoms of paroxetine-induced urinary retention might include:
- difficulty urinating,
- increased urge to urinate again,
- not emptying the bladder completely due to decreased sensitization,
- a weak stream of urine with irregular flow,
- lower abdominal pain.
How to reduce the risks of urinary retention while taking paroxetine?
- The patient must give a complete and thorough medical history to the doctor, including previous episodes of urinary retention.
- The patient should disclose the use of other medication (prescription, or non-prescription) to avoid possible drug-drug interaction.
- The pharmacist and doctor must identify possible drug interactions in the current therapy.
- Urinary retention may be prevented in the high-risk patients such as the elderly, by doing complete anamnesis and physical examination.
- The pharmacist should closely monitor the use of concomitant drugs.
- The doctor can select the lowest dose of paroxetine and work up the dose according to the response.
Who is at higher risk?
As paroxetine-induced urinary retention is uncommon (0.1-1%), it is difficult to establish who can develop this side effect. However, the chances of urinary retention are higher in the elderly, pregnant women, or postmenstrual women. It is more common in men than women (4).
How to treat paroxetine-induced urinary retention?
- Urinary catheterisation,
- reduction in the dose of paroxetine,
- changing the medication,
- antibiotic treatment in case of urinary tract infection,
- physical therapy if the patient has pelvic floor dysfunction.
Does paroxetine-induced urinary retention go away?
With proper treatment, paroxetine-induced urinary retention does go away. It is important to consult the doctor immediately if symptoms of urine retention appear while taking paroxetine. Do not stop the medication without consulting the doctor first.
Delaying therapy simply makes the situation worse. There is no reason to be embarrassed when reporting the side effects. A doctor may diagnose and treat the issue. In extreme cases, however, the patient may be referred to a urologist, or pelvic floor specialist for additional testing and treatment.
Which other factors can induce urinary retention with paroxetine?
There are several other factors which can cause urinary retention. These might include:
- Neurological disorder
- diabetes,
- prostatic hypertrophy,
- swelling of the urethra due to infection,
- bladder obstructions, and
- prostrate cancer.
Which drugs can increase the chances of urinary retention?
Most of the time the concomitant use of other medications, rather than paroxetine, can cause urinary retention. These drugs might include (5):
- anticholinergic,
- benzodiazepines,
- opioids,
- calcium channel antagonists,
- Nonsteroidal antiinflamatrory drugs (NSAIDs),
- alpha-adrenoreceptor agonists, and
- detrusor relaxants.
Conclusion
In this article, we described how paroxetine might cause urinary retention. It is important to work with your doctor in designing a tapering regimen that will gradually lower the chances of urinary retention.
I stress that you should always provide a complete medical history to your doctor. You should inform him if you have previously experienced urinary retention. Also, avoid the concomitant use of non-prescribed medicine while you are on paroxetine.
Was this helpful?
References
1.-
Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug safety. 2008 May;31:373-88. https://link.springer.com/article/10.2165/00002018-200831050-00002
2.-
Viktrup L, Pangallo BA, Detke MJ, Zinner NR. Urinary side effects of duloxetine in the treatment of depression and stress urinary incontinence. Primary care companion to the Journal of clinical psychiatry. 2004;6(2):65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC427601
3.-
Burgard EC, Fraser MO, Thor KB. Serotonergic modulation of bladder afferent pathways. Urology. 2003 Oct 1;62(4):10-5. https://www.sciencedirect.com/science/article/abs/pii/S0090429503005909
4.-
Lenze EJ. Reversal of SSRI-associated urinary retention with mirtazapine augmentation. Journal of clinical psychopharmacology. 2012 Jun 1;32(3):434. https://journals.lww.com/psychopharmacology/citation/2012/06000/reversal_of_ssri_associated_urinary_retention_with.29.aspx
5.-
Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug safety. 2008 May;31:373-88. https://pubmed.ncbi.nlm.nih.gov/18422378
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