From the Guidelines
Trazodone is not suitable for patients unable to urinate and poo due to its anticholinergic effects, which can worsen urinary retention and constipation. This medication, primarily used for depression and insomnia, can further relax bladder muscles and slow intestinal motility, exacerbating the condition in susceptible individuals. For patients already struggling with these issues, alternative medications for sleep or mood disorders should be considered, such as medications with fewer anticholinergic properties 1. If a patient on trazodone develops difficulty urinating or constipation, they should contact their healthcare provider immediately, as these symptoms could indicate a need to adjust their medication regimen. The healthcare provider might recommend increasing fluid intake, physical activity, or dietary fiber while exploring medication alternatives that won't interfere with urinary or bowel function, as suggested by studies on managing constipation and urinary retention 1. Key considerations include the use of osmotic laxatives, such as macrogols or lactulose, to increase the amount of water in the large bowel, or stimulant laxatives, like sennosides, to increase intestinal motility, but with caution to avoid excessive use and potential side effects 1. Additionally, medications like linaclotide, a guanylate cyclase-C agonist, have been shown to be efficacious in managing constipation, particularly in cases of irritable bowel syndrome with constipation, although they may have side effects like diarrhea 1. Ultimately, the choice of medication and management strategy should prioritize minimizing morbidity, mortality, and improving quality of life for the patient.
From the FDA Drug Label
6.1 Clinical Trials Experience ... Other adverse reactions occurring at an incidence of <2% with the use of trazodone hydrochloride in the controlled clinical studies: ... delayed urine flow, ... 6.2 Post marketing Experience ... Renal and urinary disorders: urinary incontinence, urinary retention
The use of trazodone may be associated with urinary retention in some patients. There is no direct information in the label regarding the safety of trazodone in patients who are unable to urinate. Regarding bowel movements, there is no direct information in the label about the safety of trazodone in patients who are unable to poo. Therefore, caution should be exercised when prescribing trazodone to patients with urinary or bowel issues 2.
From the Research
Trazodone and Urinary Retention
- Trazodone has been associated with urinary retention in some cases, particularly in patients with underlying medical conditions such as benign prostatic hyperplasia 3.
- A study published in 2018 reported a case of acute urinary retention in a patient with benign prostatic hyperplasia who was treated with a combination of suboxone, lurasidone, and trazodone 3.
- However, another study published in 2019 found that trazodone has a low risk of anticholinergic side effects, including urinary retention 4.
Management of Urinary Retention
- Urinary retention is generally treated by urinary catheterization, especially if acute, in combination with discontinuation or a reduction in dose of the causal drug 5.
- In patients with underlying neurologic causes of urinary retention, management may involve monitoring in conjunction with neurology and urology subspecialists 6.
Considerations for Patients with Urinary Retention
- Patients with urinary retention should undergo a detailed evaluation, including a physical examination and diagnostic testing, to determine the underlying cause of the condition 6.
- The use of trazodone in patients with urinary retention should be carefully considered, taking into account the potential risks and benefits of the medication 3, 4.