Can lithium or similar medications cause urinary symptoms in patients with urinary tract or prostate issues?

Dexilant and Urinary Symptoms

Dexilant (dexlansoprazole), a proton pump inhibitor used for GERD and erosive esophagitis, does not cause urinary symptoms as a recognized side effect. The question appears to confuse Dexilant with lithium, which is well-documented to cause urinary symptoms.

Lithium-Induced Urinary Symptoms

Lithium causes polyuria (excessive urination) in up to 35% of patients and can lead to secondary enuresis (urinary incontinence), particularly when combined with sedating medications. 1, 2

Primary Urinary Effects of Lithium

• Polyuria and polydipsia are the most common urinary side effects, occurring as early signs even at therapeutic lithium levels below 2 mEq/L 2
• The FDA label specifically lists "a large output of dilute urine" as a manifestation of lithium toxicity, along with "polyuria, sometimes resembling diabetes insipidus" 2
• Secondary enuresis (loss of bladder control after previously being dry) has been reported as a medication side effect of lithium, though relatively uncommon 1

Mechanism and Clinical Presentation

• Lithium interferes with the kidney's ability to concentrate urine, leading to increased urine production that can disrupt normal bladder function 2, 3
• When combined with psychotropic medications that have sedative properties (benzodiazepines, antipsychotics), lithium increases the risk of nocturnal enuresis because patients may not wake to void despite a full bladder 3
• One case report documented a 12-year-old girl who developed nocturnal enuresis while on lithium carbonate extended-release tablets (1.2g daily), which completely resolved after lithium discontinuation 3

Critical Monitoring Considerations

• Polyuria may indicate impending lithium toxicity and warrants immediate serum lithium level measurement 2
• Urinary symptoms typically appear during initial therapy and may persist throughout treatment, requiring dose adjustment or discontinuation 2
• In patients with pre-existing prostate issues or bladder outlet obstruction, lithium-induced polyuria can worsen urinary frequency and urgency 1

Management Algorithm

• If polyuria develops: Check serum lithium levels immediately, assess hydration status, and consider dose reduction 2
• If enuresis occurs: Evaluate for concomitant sedating medications, consider switching to single daily dosing (though evidence for benefit is limited), or discontinue lithium if symptoms are severe 1, 4, 3
• For patients with urinary tract pathology: Imaging of the urinary tract should be part of routine work-up in patients with lithium toxicity symptoms, as concomitant urinary lesions can impair lithium excretion and worsen toxicity 5

Common Pitfall to Avoid

• Do not dismiss polyuria as a benign inconvenience—it may signal lithium toxicity or underlying urinary tract pathology that impairs renal function and lithium clearance 2, 5