Can Lexapro Cause UTI?
Lexapro (escitalopram) does not directly cause urinary tract infections, but it is associated with urinary retention as a rare adverse effect, which can secondarily increase UTI risk. 1
Direct Evidence from FDA Labeling
The FDA-approved prescribing information for escitalopram lists urinary tract infection as a reported adverse event in pediatric patients (ages 6-17 years) with major depressive disorder, occurring at an incidence of at least 2% and greater than placebo. 1 However, this does not establish a direct causal mechanism—rather, it reflects observed associations in clinical trials.
In adult populations, the FDA label does not list UTI as a common adverse reaction. 1
Mechanism: Urinary Retention as the Link
The more clinically relevant concern is that escitalopram can cause acute urinary retention (AUR), particularly in vulnerable populations:
- Case reports document escitalopram-associated AUR in elderly men with known or latent benign prostatic hyperplasia, with urinary retention resolving after drug discontinuation. 2
- A published case series describes AUR development in three elderly male patients after starting standard-dose escitalopram, with one case requiring emergent prostatectomy. 2
- Another case report documented AUR in a patient where normal micturition resumed only after stopping escitalopram, without further need for catheterization. 3
Clinical Implications
Urinary retention increases UTI risk through several mechanisms:
- Increased residual urine volume creates a favorable environment for bacterial growth 4
- Drugs affecting normal voiding processes are recognized as iatrogenic factors contributing to UTI development 4
- Compromised urinary outflow may warrant consideration as a relative contraindication for escitalopram treatment, particularly in elderly men 2
Risk Stratification
Highest risk patients include:
- Elderly men with known or latent benign prostatic hyperplasia 2
- Patients with pre-existing voiding dysfunction 4
- Individuals with marginal urinary outflow 2
Practical Recommendations
Before initiating escitalopram:
- Screen for urinary symptoms, particularly in elderly male patients 2
- Assess for history of urinary retention or voiding difficulties 3
- Consider alternative antidepressants in patients with significant prostatic hypertrophy 2
During treatment:
- Monitor for new-onset urinary symptoms (hesitancy, incomplete emptying, frequency) 3, 2
- If urinary retention develops, discontinue escitalopram and assess for resolution 3, 2
- If UTI develops in the context of new urinary symptoms, evaluate for retention as a contributing factor 4
Important Caveat
Selective serotonin reuptake inhibitors are not typically suspected as causes of urinary complications, which may lead to delayed recognition and attribution to other medications (such as anticholinergics or antihistamines). 3 Maintain clinical vigilance for this rare but documented adverse effect.