Can Trazodone Cause Bedwetting?
Yes, trazodone can cause urinary incontinence including bedwetting (nocturnal enuresis), though this is not a commonly emphasized side effect in the FDA labeling.
Evidence from FDA Drug Label
The FDA label for trazodone 1 1 1 lists urinary incontinence as a post-marketing adverse reaction under "Renal and urinary disorders." This means cases have been reported after the drug's approval, though the exact frequency cannot be determined from voluntary reporting systems. The label also mentions urinary retention as a potential adverse effect, indicating trazodone can affect bladder function in multiple ways.
Clinical Context and Mechanism
While the FDA label confirms urinary incontinence as a recognized adverse effect, the mechanism is not fully elucidated but likely relates to:
- Sedation effects: Trazodone's primary side effect is sedation 2, which could impair arousal from sleep when the bladder is full
- Anticholinergic properties: Though mild, these could affect bladder control
- Central nervous system effects: Trazodone affects multiple neurotransmitter systems that may influence bladder signaling
Interestingly, one small self-study 3 found that trazodone did NOT reduce nocturia (nighttime urination frequency) compared to placebo, suggesting it doesn't improve bladder control during sleep and may even impair normal arousal mechanisms.
Clinical Implications
If a patient develops new-onset bedwetting after starting trazodone:
- Consider trazodone as a potential causative agent
- Evaluate timing of dose (bedtime dosing 2 may increase risk)
- Assess for other contributing factors (fluid intake, sleep disorders, other medications)
- Consider dose reduction or switching to an alternative antidepressant if bedwetting is problematic
Important Caveats
- This is not listed among the most common adverse reactions in clinical trials 1
- The incidence appears relatively low based on available data
- Other medications and medical conditions should be ruled out as causes
- In children and adolescents, this side effect may be particularly distressing and affect medication adherence
The bottom line: Trazodone is a documented cause of urinary incontinence per FDA labeling 1 1, and clinicians should consider it when evaluating new-onset bedwetting in patients taking this medication.