Can Fluoxetine (Selective Serotonin Reuptake Inhibitor) 80 mg and Bupropion (Norepinephrine-Dopamine Reuptake Inhibitor) 150 mg affect urination in a 36-year-old male with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS)?

From the Guidelines

Yes, Fluoxetine 80 mg and Bupropion 150 mg can affect urination in this 36-year-old male patient. Both medications are known to potentially cause urinary symptoms as side effects. Fluoxetine (an SSRI antidepressant) can cause urinary hesitancy, retention, and decreased stream force in some patients. Bupropion (an NDRI antidepressant) may also contribute to urinary difficulties, though less commonly than SSRIs. The timing of the patient's symptoms (3 years duration without significant worsening) suggests a possible correlation with medication use. The normal uroflowmetry results (Qmax 24.8 mL/s) and low post-void residual volume (29 mL) indicate no significant physical obstruction despite the prostate findings (calcifications, cyst, and hypoechoic area) 1. This supports the assessment that the urinary symptoms may have a psychological component or medication-related etiology. If these symptoms are bothersome to the patient, discussing a medication adjustment with his prescribing physician would be appropriate. Potential options include dose reduction, switching to alternative antidepressants with fewer urinary side effects, or adding medication to address the urinary symptoms specifically. The patient should be monitored for any worsening of symptoms, particularly given the prostate findings that require routine follow-up. According to the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms, the management of LUTS should be based on the patient's symptoms, quality of life, and preferences 1. In this case, the patient's symptoms are likely related to the medication use, and a medication adjustment may be necessary to alleviate the symptoms. It is also important to note that the patient's prostate findings require routine follow-up, and any changes in symptoms or prostate health should be closely monitored. Overall, the patient's symptoms and prostate health should be managed in a way that prioritizes his quality of life and minimizes the risk of complications.

Some key points to consider in the management of this patient's symptoms include:

• The patient's medication use and potential side effects on urination
• The patient's prostate findings and the need for routine follow-up
• The patient's quality of life and preferences in managing his symptoms
• The potential benefits and risks of different treatment options, including medication adjustment and adding medication to address urinary symptoms specifically. It is essential to weigh the benefits and risks of each option and make a decision based on the most recent and highest-quality evidence, such as the 2023 European Association of Urology guidelines 1.

From the FDA Drug Label

The elimination of the major metabolites of bupropion may be affected by reduced renal or hepatic function, because they are moderately polar compounds and are likely to undergo further metabolism or conjugation in the liver prior to urinary excretion Bupropion is extensively metabolized in the liver to active metabolites, which are further metabolized and subsequently excreted by the kidneys. The elimination of the major metabolites of bupropion may be reduced by impaired renal function

The patient has no evidence of obstruction and normal renal function as indicated by the PVR of 29 mL and Uroflowmetry Qmax of 24.8 mL/s. However, the patient has bilateral multiple calcifications of the gland, Thick bladder walls, and Mid gland hypoechoic area. Considering the patient's renal function is normal, the use of Bupropion 150 mg is unlikely to affect urination. However, Fluoxetine 80 mg is not discussed in the provided drug label, so its effect on urination cannot be determined from this information. Given the available information about Bupropion, it is unlikely to affect urination in this patient 2.

From the Research

Medication Effects on Urination

• The patient is taking Fluoxetine 80 mg and Bupropion 150 mg, but there is no direct evidence in the provided studies that these medications affect urination in the context of the patient's symptoms.
• The studies primarily discuss alpha-blockers and their role in treating lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) 3, 4, 5, 6.
• Fluoxetine is discussed in the context of treating depression associated with physical illness, with no mention of its effects on urination 7.

Patient's Symptoms and Diagnosis

• The patient has a subjective feeling of difficulty urinating, occasional slow urinary stream, occasional hesitancy to start urination, and weak ejaculation.
• The pelvic sonogram revealed a prostate size of 24 g, bilateral multiple calcifications of the gland, thick bladder walls, and other abnormalities.
• The uroflowmetry results showed a Qmax of 24.8 mL/s, and the patient was reassured that there was no evidence of obstruction, with a possible psychological component to his symptoms.

Alpha-Blockers and Urination

• Alpha-blockers are commonly used to treat LUTS associated with BPH, and they work by relaxing smooth muscle in the prostate and reducing outlet resistance 3, 4, 5, 6.
• The studies discuss the efficacy and safety of different alpha-blockers, including terazosin, doxazosin, tamsulosin, alfuzosin, and silodosin, but do not mention Fluoxetine or Bupropion as treatments for LUTS 3, 4, 5, 6.