What medications can cause decreased urine output and increased blood pressure?

Medications That Can Cause Decreased Urine Output and Increased Blood Pressure

Several medications can simultaneously cause decreased urine output and increased blood pressure, with nonsteroidal anti-inflammatory drugs (NSAIDs) being the most significant class affecting both parameters. 1

NSAIDs

NSAIDs are the primary medications that can cause both decreased urine output and elevated blood pressure through several mechanisms:

• Mechanism of action: NSAIDs inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis 2

• Renal effects:

  • Reduce renal blood flow and glomerular filtration rate
  • Decrease sodium excretion, causing fluid retention
  • Blunt the natriuretic effect of loop diuretics and thiazides 3
  • Can lead to acute renal failure in high-risk patients

• Blood pressure effects:

  • Increase blood pressure by 3/1 mmHg with nonselective NSAIDs 1
  • Antagonize the effects of RAAS-inhibitors and beta-blockers 1
  • Counteract prostaglandin-dependent vasodilatory tone 4

Clinical significance:

• Effects are more pronounced in elderly patients, those with higher baseline BP, patients on antihypertensive therapy, or those with kidney disease 1
• Risk of decreased urine output is highest in patients with compromised renal perfusion who depend on prostaglandin synthesis to maintain normal renal function 5

Other Medications That Affect Both Parameters

Alpha-1 Adrenergic Receptor Blockers

• While typically used to improve urinary symptoms, they can paradoxically cause urinary retention in some patients 6
• Can impair renal sodium and water retention in patients with a solitary kidney 7
• Require careful monitoring in patients with pre-existing renal insufficiency 7

Vasopressors

• Vasopressors used in shock can increase blood pressure while potentially reducing urine output through vasoconstriction
• Vasopressin at high doses can markedly impair splanchnic circulation and renal perfusion 1

Calcineurin Inhibitors

• Listed as medications that can increase blood pressure 1
• Can cause nephrotoxicity leading to decreased urine output

Steroids

• Can cause sodium and fluid retention leading to decreased urine output
• Listed as medications that can increase blood pressure 1

Medications That Primarily Affect Blood Pressure

Several other medications can increase blood pressure without directly affecting urine output:

• Combined oral contraceptive pills: 6/3 mmHg increase with high doses of estrogen 1
• Antidepressants:
  • SNRIs cause 2/1 mmHg increase
  • Tricyclic antidepressants increase odds ratio of hypertension by 3.19 1
• Acetaminophen: Increased relative risk of 1.34 for hypertension with almost daily use 1
• Sympathomimetics: pseudoephedrine, cocaine, amphetamines 1
• Other medications: antimigraine serotonergics, recombinant human erythropoietin, antiangiogenesis and kinase inhibitors 1
• Herbal substances: alcohol, ma-huang, ginseng at high doses, licorice, St. John's wort, yohimbine 1

Clinical Approach

When evaluating a patient with decreased urine output and increased blood pressure:

1. Review medication list for NSAIDs, alpha-blockers, vasopressors, calcineurin inhibitors, and steroids
2. Assess renal function with serum creatinine, eGFR, and urinalysis 1
3. Consider discontinuing the offending agent when possible
4. Monitor closely for signs of worsening renal function in high-risk patients:
   • Elderly
   • Those with pre-existing renal disease
   • Patients with heart failure
   • Patients taking multiple medications that affect renal function

Important Considerations

• The individual effect of these medications on blood pressure and urine output can be highly variable 1
• Combination therapy with multiple agents affecting renal function (e.g., NSAIDs with diuretics or ACE inhibitors) significantly increases risk 3
• Calcium channel blockers may be preferable for hypertension control in patients requiring NSAIDs, as their efficacy is less affected by NSAIDs 4

Remember that medication-induced changes in urine output and blood pressure are often reversible upon discontinuation of the offending agent, but can lead to significant morbidity if not recognized promptly.