Does Lexapro (escitalopram) cause frequent urination?

Does Lexapro Cause Frequent Urination?

Lexapro (escitalopram) does not typically cause frequent urination as a common side effect, but it can rarely cause urinary retention (difficulty urinating) rather than increased urination frequency. 1

Common Side Effects of Lexapro

The FDA-approved prescribing information and clinical reviews identify the most frequent adverse effects of escitalopram, which do not include frequent urination 1, 2:

• Nausea (most common reason for discontinuation) 3, 1
• Sleepiness and dizziness 1
• Sexual dysfunction 3, 1
• Dry mouth and constipation 1
• Sweating and weakness 1
• Insomnia and anxiety 1
• Headache 1

In pediatric and adolescent populations specifically, the FDA label notes "increased thirst" and "difficult urination" as potential side effects—but not frequent urination 1.

Rare Urinary Side Effects: Retention, Not Frequency

Acute Urinary Retention Risk

Escitalopram has been associated with acute urinary retention (AUR), particularly in specific patient populations 4, 5:

• Elderly men with benign prostatic hyperplasia (BPH) are at highest risk for developing urinary retention when starting escitalopram 5
• Three documented cases showed AUR development in men with known or latent BPH after starting standard doses of escitalopram 5
• Urinary retention resolved after discontinuing escitalopram in most cases, though one patient required emergent prostatectomy 5
• This side effect is often overlooked due to limited reporting in the literature 4

Mechanism and Clinical Implications

While SSRIs are not typically anticholinergic, escitalopram can rarely cause urinary retention through unclear mechanisms 4. This represents difficulty emptying the bladder rather than increased urination frequency 4, 5.

Hyponatremia and SIADH: Indirect Effects on Urination

Escitalopram can rarely cause syndrome of inappropriate antidiuretic hormone (SIADH), which leads to water retention and hyponatremia rather than increased urination 6:

• SIADH causes the body to retain water inappropriately 6
• This results in decreased urine output and concentrated urine, not frequent urination 6
• High-risk patients (elderly, those on diuretics) should be monitored for hyponatremia 6

Clinical Recommendations

If a patient reports increased urination while taking Lexapro:

• Investigate alternative causes first, as this is not a recognized side effect of escitalopram 1, 2
• Consider diabetes, urinary tract infection, excessive fluid intake, or other medications 1
• Evaluate for polydipsia (increased thirst), which is listed as a pediatric side effect and could lead to secondary increased urination 1

For patients with urinary symptoms:

• Elderly men with BPH should be monitored closely when starting escitalopram for signs of urinary retention 5
• Compromised urinary outflow may warrant consideration of alternative antidepressants 5
• If urinary retention develops, discontinue escitalopram and consider urological evaluation 4, 5