Can Trintellix and Trazodone Cause Urinary Issues?
Yes, both Trintellix (vortioxetine) and trazodone can cause urinary problems, though the risk profile differs between the two medications and the specific type of urinary issue matters.
Trintellix (Vortioxetine)
The FDA-approved prescribing information for Trintellix does not list urinary retention, urgency, or incontinence as recognized adverse effects 1. The drug label comprehensively details numerous side effects including sexual dysfunction, but urinary problems are notably absent from both common and serious adverse reaction listings.
Trazodone
Trazodone has documented urinary side effects, particularly urinary retention and incontinence. The FDA label explicitly lists both urinary incontinence and urinary retention as post-marketing adverse reactions 2.
Evidence for Trazodone's Urinary Effects:
Urinary retention: A case report documented acute urinary retention in a 60-year-old man with benign prostatic hyperplasia treated with trazodone (along with other medications) 3. A systematic review found that antidepressants, including trazodone, are linked to urinary retention, with improvement typically occurring upon discontinuation or dose reduction 4.
Mechanism: Trazodone has anticholinergic properties that can impair bladder emptying, particularly in vulnerable populations (elderly men, those with pre-existing prostatic issues) 5.
Clinical context: Interestingly, one review noted trazodone has a "relatively low risk of anticholinergic effects such as urinary retention" compared to tricyclic antidepressants 6, suggesting the risk exists but may be lower than with older antidepressants.
Risk Stratification
Higher Risk Patients:
- Men with benign prostatic hyperplasia are at substantially increased risk for urinary retention with trazodone 3, 5
- Elderly patients (>65 years) due to age-related bladder changes and comorbidities 5
- Patients on multiple medications with anticholinergic or alpha-adrenergic effects 3
Type of Urinary Problem:
- Voiding symptoms (retention, hesitancy): More common with trazodone, particularly in men 7
- Storage symptoms (urgency, incontinence): Trazodone can cause incontinence per FDA labeling 2, though this appears less common than retention
Clinical Recommendations
For patients starting trazodone:
- Explicitly ask about baseline urinary function before initiation
- In men over 50 or those with known prostatic issues, consider alternative antidepressants with lower anticholinergic burden
- Monitor for new-onset difficulty urinating, weak stream, or incomplete emptying within the first 2 weeks of treatment
- If urinary retention develops, discontinue trazodone—symptoms typically resolve within 2 days of stopping 3
For patients on Trintellix:
- Urinary issues are not an expected side effect based on current evidence
- If urinary problems develop, investigate other causes or concomitant medications rather than attributing to vortioxetine
Important Caveat
The provided guidelines [8-9] focus on medications that cause urinary incontinence (primarily antimuscarinics) rather than medications that cause urinary problems as side effects. The guideline emphasizes that clinicians should identify whether patients are receiving medications that may cause or worsen urinary incontinence 8, but neither Trintellix nor trazodone are mentioned in these guidelines as causative agents for incontinence.