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LETTER TO THE EDITOR Table of Contents   
Year : 2005  |  Volume : 47  |  Issue : 2  |  Page : 130
Reboxetine-induced urinary hesitancy


Department of Psychiatry, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai 400022, India

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Date of Web Publication24-Sep-2009
 

How to cite this article:
Borade S, Bhirud M, Kadam K. Reboxetine-induced urinary hesitancy. Indian J Psychiatry 2005;47:130

How to cite this URL:
Borade S, Bhirud M, Kadam K. Reboxetine-induced urinary hesitancy. Indian J Psychiatry [serial online] 2005 [cited 2019 Jul 23];47:130. Available from: http://www.indianjpsychiatry.org/text.asp?2005/47/2/130/55964


Sir,

One of the troublesome side-effects of tricyclic anti­depressants is urinary hesitancy due to their anticholinergic effects. [1]

Reboxetine, the only selective noradrenaline reuptake inhibitor, is an effective and well-tolerated antidepressant. Since it has low affinity for muscarinic, cholinergic receptors, [2] anticholinergic side-effects such as urinary retention or hesitancy are not expected.

However, some patients on reboxetine (2-4 mg/day) complain of urinary hesitancy. A peripheral noradrenergic mechanism termed 'pseudoanticholinergic syndrome' may be responsible for this side-effect. [3]

Tamsulosin, an alpha-1A receptor antagonist, is recommended for reboxetine-induced urinary hesitancy. [4],[5] Therefore, the following precautions should be taken while a patient is on reboxetine:

  1. Enquire about any history of urinary complaints beforehand.
  2. In elderly patients, titrate the dose upwards gradually.
  3. During follow-up visits, ask patients whether they have any urinary hesitancy.
  4. If reboxetine-induced urinary hesitancy does set in, then rather than withdrawing reboxetine, a trial of capsule tamsulosin (available locally as Urinat) can be started in a single dose of 0.4 mg half-an-hour after dinner every day.


 
   References Top

1.Sadock BJ, Sadock AV. Tricyclics and tetracyclics. In: Cancro R (ed). Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams& Wilkins; 2003:1125-31.  Back to cited text no. 1      
2.Sadock BJ, Sadock AV. Reboxetine. In: Cancro R (ed). Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams& Wilkins; 2003:1092-3.  Back to cited text no. 2      
3.Stahl SM. Classical antidepressants, serotonin selective reuptake inhibitors, and noradrenergic reuptake inhibitors. In: Essential psychopharmacology. 2nd ed. New Delhi: Cambridge University Press; 2003:199-243.  Back to cited text no. 3      
4.Dermyttenaire K, Huygens R, Van Buggenhout R. Tamsulosin as an effective treatment for reboxetine associated urinary hesitancy. Int Clin Psychopharmacol 2001;16:353-5.  Back to cited text no. 4      
5.Kasper S, Wolf R. Successful treatment of reboxetine induced urinary hesitancy with tamsulosin. Eur Neuropsychopharmacol 2002;12:119-22.  Back to cited text no. 5      

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Correspondence Address:
Suresh Borade
Department of Psychiatry, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai 400022
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.55964

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