What medications are associated with urinary frequency?

Medications Associated with Urinary Frequency

Numerous medications can cause urinary frequency as a side effect, with diuretics, antimuscarinics, and certain psychotropic medications being the most common culprits. 1, 2

Diuretics

• Loop diuretics (e.g., furosemide) cause increased urine production by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to increased urinary frequency 2, 3
• Thiazide diuretics (e.g., hydrochlorothiazide) work in the distal convoluted tubule and can cause increased urinary frequency, though generally less potently than loop diuretics 3, 4
• Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) act on the distal tubule and collecting duct, contributing to increased urination 4
• Mineralocorticoid receptor antagonists like spironolactone can cause urinary frequency as noted in heart failure trials 1

Antimuscarinic Medications

• Medications with antimuscarinic properties (opposite of those used to treat urinary incontinence) can cause urinary frequency as a side effect 1
• Common examples include:
  • Tricyclic antidepressants
  • First-generation antihistamines
  • Certain antipsychotics
  • Some Parkinson's disease medications 1

Psychotropic Medications

• Selective serotonin reuptake inhibitors (SSRIs) like sertraline can cause hyponatremia through syndrome of inappropriate antidiuretic hormone secretion (SIADH), which may present with urinary frequency 5
• Elderly patients and those taking diuretics are at higher risk for SSRI-induced hyponatremia 5

Medications That Affect Bladder Function

• Alpha-blockers used for hypertension can cause urinary frequency by relaxing bladder neck and prostatic smooth muscle 1
• Calcium channel blockers may reduce bladder contractility, potentially leading to urinary frequency and incomplete emptying 1

Medications That Increase Fluid Intake

• Lithium causes nephrogenic diabetes insipidus with polyuria and polydipsia 1
• Vasopressin analogues can worsen urinary frequency in certain conditions 1

Medications That Affect Renal Function

• NSAIDs can cause urinary frequency through effects on renal prostaglandins and water retention 1
• Certain antibiotics, particularly aminoglycosides, may affect renal tubular function leading to increased urination 1

Special Considerations

• Elderly patients are more susceptible to medication-induced urinary frequency due to age-related changes in pharmacokinetics 1
• Patients with chronic kidney disease require special attention when prescribed medications that can affect urinary patterns 1
• Patients taking multiple medications (polypharmacy) are at higher risk for drug-induced urinary frequency 1

Management Approach

• Consider medication review when evaluating patients with new-onset urinary frequency 6
• Adjust timing of diuretic administration (e.g., morning rather than evening) to minimize nighttime urinary frequency 2
• For essential medications causing urinary frequency, consider dose reduction when possible 1
• Balance the benefits of the medication against the impact of urinary frequency on quality of life 1

Monitoring

• Monitor electrolytes in patients taking diuretics, as electrolyte imbalances can worsen urinary symptoms 2
• Assess for signs of dehydration in patients with medication-induced urinary frequency 2
• Consider frequency-volume charts to quantify the impact of medications on urination patterns 6

Remember that urinary frequency is often multifactorial, and medication effects may be just one contributing factor. A thorough medication review should be part of the evaluation of any patient presenting with urinary frequency.