Bupropion and Urinary Obstruction
Bupropion does not cause urinary obstruction; in fact, it causes the opposite problem—urinary incontinence and enuresis—due to its noradrenergic and dopaminergic effects on bladder control mechanisms.
Documented Urinary Side Effects
Bupropion has been reported to cause urinary incontinence, not retention or obstruction. Case reports document diurnal enuresis (daytime urinary incontinence) in a 61-year-old man treated with bupropion sustained-release 1 and nocturnal urinary incontinence in patients using the extended-release formulation 2. These effects represent loss of bladder control rather than obstruction.
- Urinary symptoms were noted during clinical trials but are considered relatively rare adverse effects 1.
- The mechanism involves bupropion's action as a norepinephrine-dopamine reuptake inhibitor, which affects the neuropharmacology of urinary control 1.
Common Adverse Effects (Not Including Obstruction)
The most frequently reported side effects of bupropion include 3, 4, 5:
- Neurological: Headache, insomnia, dizziness, tremor, agitation
- Gastrointestinal: Dry mouth, nausea, constipation, vomiting
- Cardiovascular: Tachycardia, elevated blood pressure 3
Anticholinergic Profile
Bupropion produces minimal anticholinergic effects compared to tricyclic antidepressants 6. This is clinically significant because:
- Anticholinergic medications are the agents that typically cause urinary retention and obstruction.
- Bupropion's lack of anticholinergic activity makes it a preferred choice in older adults specifically to avoid anticholinergic side effects 6.
- The American Geriatric Society lists bupropion among preferred antidepressants precisely because it does not carry the anticholinergic burden that would cause urinary retention 6.
Clinical Implications
If a patient on bupropion develops urinary obstruction, look for alternative causes:
- Concurrent anticholinergic medications (antihistamines, tricyclic antidepressants, antipsychotics)
- Benign prostatic hyperplasia in men
- Other anatomical or neurological causes of obstruction
The documented urinary side effect of bupropion is incontinence (loss of control), not obstruction (inability to void) 1, 2. This distinction is critical for clinical management—if obstruction occurs, it is not attributable to bupropion's pharmacology.