Does Bupropion Cause Lower Urinary Tract Symptoms (LUTS)?
Yes, bupropion can cause lower urinary tract symptoms, specifically urinary frequency, though this is a relatively rare adverse effect. The FDA-approved drug label for bupropion explicitly lists urinary frequency as one of the most common adverse reactions (incidence ≥5%; ≥2× placebo rate) 1. Additionally, a case report documented diurnal enuresis (daytime urinary incontinence) as a previously unreported adverse effect in a 61-year-old man treated with bupropion sustained release 2.
Evidence from FDA Drug Labeling
- Urinary frequency is listed among the most common adverse reactions with bupropion, occurring at an incidence ≥5% and at least twice the placebo rate 1.
- The FDA label notes that "urinary symptoms were noted during the clinical trials," though these are characterized as "relatively rare adverse effects" 2.
- Other common adverse effects include dry mouth, nausea, insomnia, dizziness, agitation, anxiety, and tremor 1.
Clinical Case Evidence
- A documented case report describes a 61-year-old man who developed diurnal enuresis during treatment with bupropion HCl sustained release, representing a previously unreported urinary adverse effect 2.
- This case highlights that urinary symptoms can manifest beyond simple frequency to include incontinence in some patients 2.
Mechanism and Clinical Context
- Bupropion functions as a norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist, which may explain its effects on urinary function through autonomic nervous system modulation 2, 3.
- The medication has no significant direct effects on serotonin neurotransmission, distinguishing it from SSRIs in its side effect profile 4, 3.
- Among antidepressants, bupropion has among the lowest incidence of sexual dysfunction, weight gain, and somnolence, but urinary symptoms represent a distinct adverse effect category 4.
Clinical Recommendations
- Monitor patients on bupropion for new-onset urinary frequency or other LUTS, particularly in the first weeks of treatment 1, 2.
- If urinary symptoms develop and are bothersome, consider dose reduction or switching to an alternative antidepressant, as these symptoms may be dose-related 1.
- Do not confuse bupropion-induced urinary frequency with other causes of LUTS such as benign prostatic hyperplasia in older men, which requires different management 5, 6.
- Patients should be counseled about this potential side effect before initiating therapy 1.
Important Caveats
- While urinary frequency is listed as a common adverse effect, the absolute incidence remains relatively low compared to other bupropion side effects 2.
- The development of frank urinary incontinence appears to be rare, with limited case reports in the literature 2.
- Urinary symptoms typically resolve with discontinuation of the medication, though the time course for resolution is not well-documented 2.