Does paroxetine cause urinary retention? (+2 causes)

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.


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. 

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Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug safety. 2008 May;31:373-88.


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.


Burgard EC, Fraser MO, Thor KB. Serotonergic modulation of bladder afferent pathways. Urology. 2003 Oct 1;62(4):10-5.


Lenze EJ. Reversal of SSRI-associated urinary retention with mirtazapine augmentation. Journal of clinical psychopharmacology. 2012 Jun 1;32(3):434.


Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug safety. 2008 May;31:373-88.

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