Psychotropics and Urinary Retention

High-Risk Patient Populations

• Elderly patients are at substantially elevated risk of urinary retention due to pre-existing benign prostatic hypertrophy, polypharmacy with multiple anticholinergic medications, compromised cardiovascular and autonomic function, and cognitive impairment, as reported by the American Geriatrics Society 1, 2
• The American Geriatrics Society recommends regular medication list review to identify drug-drug interactions and monitor for urinary retention as part of comprehensive geriatric assessment in high-risk patients 1, 2, 3

Clinical Monitoring Algorithm

• The European Urology association suggests that for high-risk patients, baseline assessment before initiating olanzapine, clozapine, or TCAs should include measuring electrolytes, BUN, and creatinine, and documenting urinary symptoms and post-void residual if available 1, 2
• The European Urology association recommends early monitoring period with check of electrolytes, BUN, and creatinine every 2-3 days for 1-2 weeks after initiation, and repeat after each dose increase, as well as assess for decreased urinary output, suprapubic discomfort, or changes in voiding pattern 4, 5

Management When Urinary Retention Occurs

• The American Geriatrics Society suggests that prevention strategies include avoiding combining multiple anticholinergic agents, considering alternative psychotropics with lower anticholinergic profiles, and addressing reversible causes including fecal impaction, restricted mobility, and urinary tract infections 3

Trazodone-Associated Urinary Retention

Introduction to Risk Factors

• The European Heart Journal guidelines classify antiarrhythmic drugs with anticholinergic effects as causing urinary retention, dry mouth, and constipation, reinforcing that any medication with anticholinergic properties poses this risk 6