From the Guidelines
In a 73-year-old female with urinary retention, anticholinergic medications, such as oxybutynin, and old antihistamines, like diphenhydramine and hydroxyzine, should be discontinued first. These medications can cause broad muscarinic receptor blockade, CNS impairment, and urine retention, as noted in a 2021 study on polypharmacy management in older patients 1. Other medications that may contribute to urinary retention include muscle relaxants, like cyclobenzaprine and metaxalone, and opioids, such as morphine, oxycodone, and codeine, which have anticholinergic properties and can cause sedation, cognitive impairment, and falls 1.
When discontinuing these medications, it's essential to do so gradually for some classes, like antidepressants, to avoid withdrawal symptoms, and to consider appropriate alternatives that don't affect urinary function. The patient should be monitored for improvement in urinary symptoms after medication changes, and if retention persists, further urological evaluation may be necessary.
- Key medications to discontinue or reconsider include:
- Anticholinergic medications, such as oxybutynin
- Old antihistamines, like diphenhydramine and hydroxyzine
- Muscle relaxants, like cyclobenzaprine and metaxalone
- Opioids, such as morphine, oxycodone, and codeine
- It's crucial to prioritize the patient's morbidity, mortality, and quality of life when making these medication changes, as noted in the 2021 study on polypharmacy management in older patients 1.
From the FDA Drug Label
Oxybutynin chloride is contraindicated in patients with urinary retention, gastric retention and other severe decreased gastrointestinal motility conditions, uncontrolled narrow-angle glaucoma and in patients who are at risk for these conditions. Oxybutynin chloride should be administered with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention (see CONTRAINDICATIONS)
The medication that should be discontinued in a 73-year-old female with urinary retention is oxybutynin 2 2, as it is contraindicated in patients with urinary retention.
- Key points:
- Oxybutynin chloride is contraindicated in patients with urinary retention.
- The medication should be used with caution in patients with clinically significant bladder outflow obstruction.
From the Research
Medications to Discontinue for Urinary Retention
In a 73-year-old female with urinary retention, several medications may need to be discontinued to manage the condition. These include:
- Medications with anticholinergic activity, such as:
- Antipsychotic drugs
- Antidepressant agents
- Anticholinergic respiratory agents 3
- Opioids and anaesthetics, which can impair bladder function 3
- Alpha-adrenoceptor agonists, which can increase urethral resistance 3
- Benzodiazepines, which can relax the detrusor muscle and decrease bladder contractility 3
- NSAIDs, which can decrease prostaglandin synthesis and reduce bladder contractility 3
- Detrusor relaxants, which can decrease bladder contractility 3
- Calcium channel antagonists, which can relax the detrusor muscle and decrease bladder contractility 3
Considerations for Discontinuation
When discontinuing medications, it is essential to consider the potential effects on the patient's overall health and other medical conditions. A thorough evaluation of the patient's medication list and medical history is necessary to determine the best course of action 4, 5. The patient's healthcare provider should be consulted before discontinuing any medications.
Management of Urinary Retention
Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization 4, 5. Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials 5. Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists 5.