From the Guidelines
Nasal decongestants that can cause urinary retention include pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE), with pseudoephedrine having a stronger effect. These medications work by stimulating alpha-adrenergic receptors, which constrict blood vessels in the nasal passages to reduce congestion. However, this same mechanism affects the urinary tract, causing contraction of the bladder neck and prostate smooth muscle, which can impede urine flow. Men with enlarged prostates (BPH) are particularly susceptible to this side effect, as noted in the management guidelines for benign prostatic hyperplasia 1. The risk increases with higher doses and extended-release formulations.
If you experience difficulty urinating while taking these decongestants, you should discontinue use and consult a healthcare provider. Alternative treatments for nasal congestion that don't typically cause urinary retention include saline nasal sprays, intranasal corticosteroids like fluticasone (Flonase), or antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec), as discussed in the context of rhinitis management 1.
Key points to consider:
- Pseudoephedrine and phenylephrine are the primary nasal decongestants associated with urinary retention.
- The mechanism involves stimulation of alpha-adrenergic receptors, affecting both nasal and urinary tract smooth muscle.
- Men with BPH are at higher risk due to the potential for increased urinary tract resistance.
- Monitoring and caution are advised, especially with higher doses or in patients with pre-existing urinary issues.
- Alternative treatments for nasal congestion are available and should be considered to avoid the risk of urinary retention.
From the Research
Nasal Decongestants and Urinary Retention
- Pseudoephedrine, a sympathomimetic drug widely used as a nasal decongestant, can cause voiding dysfunction, including urinary retention, particularly in older males 2.
- The use of pseudoephedrine requires extra precautions in males over 50 years, even without subjective voiding symptoms, due to the increased risk of subclinical voiding dysfunction 2.
Other Medications and Urinary Retention
- Various medications, including those with anticholinergic activity, opioids, alpha-adrenoceptor agonists, and others, can cause urinary retention 3.
- Elderly patients are at higher risk for developing drug-induced urinary retention due to existing co-morbidities and the use of concomitant medication 3.
- Opioids can cause urinary retention, and the use of a peripheral opioid antagonist, such as naldemedine, may be effective in treating this condition 4.
- Antidopaminergic medications have been associated with urinary retention in palliative care unit patients, and tapering these medications may help resolve retention 5.
Management and Prevention
- Drug-induced urinary retention is generally treated by urinary catheterization, especially if acute, in combination with discontinuation or a reduction in dose of the causal drug 3.
- Preventive measures, such as using opioids in combination with non-opioid analgesic drugs, may help reduce the incidence of postoperative urinary retention, but the effect on urinary retention yields contradictory results 3.