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Indian J Psychiatry. 2005 Apr-Jun; 47(2): 130.
PMCID: PMC2918301

Reboxetine-induced urinary hesitancy

Sir,

One of the troublesome side-effects of tricyclic anti-depressants is urinary hesitancy due to their anticholinergic effects.1

Reboxetine, the only selective noradrenaline reuptake inhibitor, is an effective and well-tolerated antidepressant. Since it has low affinity for muscarinic, cholinergic receptors,2 anticholinergic side-effects such as urinary retention or hesitancy are not expected.

However, some patients on reboxetine (2–4 mg/day) complain of urinary hesitancy. A peripheral noradrenergic mechanism termed ‘pseudoanticholinergic syndrome’ may be responsible for this side-effect.3

Tamsulosin, an alpha-1A receptor antagonist, is recommended for reboxetine-induced urinary hesitancy.4,5 Therefore, the following precautions should be taken while a patient is on reboxetine:

  1. Enquire about any history of urinary complaints beforehand.
  2. In elderly patients, titrate the dose upwards gradually.
  3. During follow-up visits, ask patients whether they have any urinary hesitancy.
  4. If reboxetine-induced urinary hesitancy does set in, then rather than withdrawing reboxetine, a trial of capsule tamsulosin (available locally as Urinat) can be started in a single dose of 0.4 mg half-an-hour after dinner every day.

REFERENCES

1. Sadock BJ, Sadock AV. Tricyclics and tetracyclics. In: Cancro R, editor. Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. pp. 1125–31.
2. Sadock BJ, Sadock AV. Reboxetine. In: Cancro R, editor. Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. pp. 1092–3.
3. Stahl SM. Essential psychopharmacology. 2nd ed. New Delhi: Cambridge University Press; 2003. Classical antidepressants, serotonin selective reuptake inhibitors, and noradrenergic reuptake inhibitors; pp. 199–243.
4. Dermyttenaire K, Huygens R, Van Buggenhout R. Tamsulosin as an effective treatment for reboxetine associated urinary hesitancy. Int Clin Psychopharmacol. 2001;16:353–5. [PubMed]
5. Kasper S, Wolf R. Successful treatment of reboxetine induced urinary hesitancy with tamsulosin. Eur Neuropsychopharmacol. 2002;12:119–22. [PubMed]

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