Can Lexapro Cause Frequent Urination?
Yes, Lexapro (escitalopram) can cause urinary symptoms including frequent urination, though this is not commonly emphasized in standard prescribing information. More concerning is that escitalopram and related SSRIs are associated with urinary retention rather than increased frequency, particularly in elderly men with benign prostatic hyperplasia 1, 2.
Understanding the Urinary Effects of SSRIs
Documented Urinary Side Effects
SSRIs including escitalopram are recognized as medications that can influence urinary continence, though this effect receives little attention from prescribers despite increasing prescription rates 3.
Escitalopram has been specifically associated with acute urinary retention (AUR) in case reports, though this is rare and often overlooked due to limited reporting 1.
The mechanism appears related to serotonergic effects on bladder function, as escitalopram demonstrates highly selective and potent inhibition of the serotonin transporter, which can affect lower urinary tract function 4.
High-Risk Populations
Elderly men with known or latent benign prostatic hyperplasia are at particular risk for developing acute urinary retention when starting escitalopram at standard doses 2.
Three documented cases showed AUR development after escitalopram initiation in men with previously diagnosed or unknown/latent BPH, with urinary retention resolving after discontinuation in two cases but requiring emergent prostatectomy in the third 2.
Medical causes of urinary retention should be ruled out first, but escitalopram may be the culprit when symptoms persist after discontinuing other suspected medications 1.
Clinical Management Approach
Initial Evaluation
When a patient develops frequent urination or urinary symptoms on escitalopram, evaluate for other causes of urinary dysfunction including urinary tract infection, diabetes, and anatomical abnormalities 5.
In elderly men, assess for benign prostatic hyperplasia as this represents a significant risk factor for escitalopram-induced urinary complications 2.
Treatment Decisions
Consider switching to a different antidepressant with potentially fewer urinary side effects if symptoms significantly impact quality of life, as recommended for managing medication-induced urinary symptoms 5, 6.
The therapeutic benefits of escitalopram in treating depression and anxiety must be weighed against urinary symptoms, particularly given that escitalopram is generally well-tolerated with mild to moderate adverse events 5, 4.
In severe cases of urinary symptoms, switching antidepressants may be necessary rather than attempting to manage symptoms while continuing the medication 6.
Important Safety Considerations
Monitoring Requirements
Escitalopram carries a risk of QT prolongation at doses exceeding 40 mg/day, which requires additional monitoring beyond urinary symptoms 5, 6.
There is increased risk of suicidal ideation, particularly in adolescents, which must be monitored alongside any urinary complaints 5.
Drug Interactions
Escitalopram has negligible inhibitory effects on CYP isoenzymes and low protein binding (56%), making clinically significant drug-drug interactions unlikely 7.
The elimination half-life is 27-33 hours with steady-state achieved in 7-10 days, meaning urinary symptoms may emerge or persist for over a week after dose changes 7.
Clinical Pitfalls to Avoid
Do not automatically attribute urinary symptoms to more commonly suspected medications (anticholinergics, antihistamines) without considering SSRIs as a potential cause 1.
Do not overlook compromised or marginal urinary outflow as a potential contraindication for escitalopram treatment, particularly in elderly men 2.
Recognize that urinary retention may persist for several days after discontinuing other suspected medications, and escitalopram discontinuation may be required for symptom resolution 1.