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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Reggie BoStar on May 23, 2006, at 9:57:11
Hi,
Lately urinating has become a project, requiring a lot of concentration, waiting, sometimes even listening to classical music on a radio in the bathroom.I've been catherized twice in emergency rooms to keep my bladder from bursting in the worst cases.
It seemed to have happened about the time my meds slowed down my sex drive, making everything from the waist down feel "detached" (as I've heard Prozac users describe it).
The problem is that I haven't been able to narrow down which of my meds might be causing this (there are some I can't stop taking). Here's the list:
Neurontin (migraine prevention) 1600 mg/day
Lamictal (mood stabilizer) 200 mg/day
Cymbalta (antidepressant) 30 mg/day
Buspar (mood stabilizer) 60 mg/day
Campral (booze cravings) 2000 mg/day
Prevacid (acid blocker) 30 mg/day
Zocor (cholesterol) 10 mg/dayAnyone have any experience with urological problem with any of these drugs?
Thanks,
Leo BoStar
Posted by Larry Hoover on May 23, 2006, at 10:29:12
In reply to Trouble urinating on various meds?, posted by Reggie BoStar on May 23, 2006, at 9:57:11
> Neurontin (migraine prevention) 1600 mg/day
> Cymbalta (antidepressant) 30 mg/dayNeurontin can do it. But, Cymbalta was first approved in North America not as an antidepressant, but as a treatment for urinary incontinence. If you can't pee, to the extent you're describing, you can damage your parts. You need to get off the Cymbalta, at least.
Lar
Posted by Declan on May 23, 2006, at 14:19:40
In reply to Trouble urinating on various meds?, posted by Reggie BoStar on May 23, 2006, at 9:57:11
I know stimulant drugs can make it difficult. That's the Cymbalta's NE thing, maybe.
Posted by ed_uk on May 23, 2006, at 14:49:54
In reply to Trouble urinating on various meds?, posted by Reggie BoStar on May 23, 2006, at 9:57:11
Cymbalta is by far the most likely culprit. Other drugs which inhibit the reuptake of NE produce similar effects. Buspar might possibly be playing a small role.
In an emergency, the urinary retention could be treated with tamsulosin (Flomax) or alfuzosin (Uroxatral), which would probably avoid the need to catheterise if taken early enough.
If necessary, tamsulosin or alfuzosin can be taken regularly to reverse the urinary side effects of noradrenergic drugs such as Cymbalta. Unfortunately, tamsulosin and alfuzosin have side effects of their own.
Ed
Posted by llrrrpp on May 23, 2006, at 14:52:58
In reply to Re: Trouble urinating on various meds?, posted by Declan on May 23, 2006, at 14:19:40
I noticed these troubles when I was taking cymbalta 30 mg. (now I take 60 mg, and I still notice it, after about 3 weeks on the med) It starts within 30 minutes of taking the dose, and gradually gets better over 24 hours. I take it at bedtime. That way, I can sleep through the worst, and in the morning there's usually enough, um, incentive to urinate. The most frustrating thing for me is a few times when I woke up in the middle of the night. I know there's pee in there, and I'm waiting, and waiting.. la di la. 5 minutes later, I'm totally awake! no fun! By noon onwards, I experience little or no "hesitation" as this symptom is quaintly called.
I noticed this side effect & I was only taking cymbalta, no other meds, no other herbals.
Posted by Phillipa on May 23, 2006, at 18:23:29
In reply to Re: Trouble urinating on various meds? » Reggie BoStar, posted by Larry Hoover on May 23, 2006, at 10:29:12
Lar are you serious? Love Phillipa
Posted by Larry Hoover on May 23, 2006, at 19:10:26
In reply to Re: Trouble urinating on various meds? » Larry Hoover, posted by Phillipa on May 23, 2006, at 18:23:29
> Lar are you serious? Love Phillipa
I wouldn't joke about that. Duloxetine was first approved for stress urinary incontinence. It is known to so powerfully constrict the outlet valve on the bladder (in extreme cases) that a syringe was needed to evacuate it. Catheters couldn't pass.
I bet they don't hardly mention that effect in the "antidepressant" monograph. Like using Wellbutrin for smoking cessation, under Zyban.
It's all about the money, eh?
Curr Opin Investig Drugs. 2000 Sep;1(1):116-21.Duloxetine Eli Lilly & Co.
Pitsikas N.
Boehringer Ingelheim, Via Lorenzini 8, Milan 20139, Italy. nikpit@yahoo.it
Lilly is developing duloxetine, a 5-HT and norepinephrine uptake inhibitor as a potential treatment for depression and urinary incontinence. In Japan, it is being jointly developed with Shionogi [187401]. Phase III trials for depression and phase II trials for urinary incontinence are underway in Japan [296442,328887]. Lilly expects to file for depression in 2002 and phase III trials for urinary incontinence are planned to start enrollment by the end of 2000 [358429,370526,373870]. Duloxetine has a half-life of 10 to 15 h in humans, and parameters reach a steady-state after 3 days of daily administration. In a 6-week, open-label study duloxetine was safe and well tolerated in 79 clinically depressed patients. Clinical response occurred in 78% of patients, and remission occurred in 60%. Insomnia and nausea occurred with an incidence of 20% [300881]. Duloxetine may offer advantages over existing antidepressants, such as Lilly's fluoxetine, because of faster recovery and fewer side effects [190226]. In June 2000, Morgan Stanley Dean Witter predicted duloxetine would reach the market in 2002 with annual sales in this year of US $50 million, rising to $200 million in 2005 [373870]. In February 1999, Deutsche Bank predicted Lilly's sales at US $200 million in 2002 rising to $400 million in 2003 [316821]. In May 2000, Deutsche Bank had made further predictions, stating that filing for duloxetine is expected in the fourth quarter of 2001, and peak sales are expected to exceed US $500 million. Also in February 1999, Lehman Brothers predicted the first major launch date (US and ex-US) to be 2002, with the year of peak sales to be 2008 [319225]. In August 1999, this prediction changed, and the expected launch date became 2001, with an 80% probability of reaching the market and sales peaking at US $150 million in 2012 [349228].
Posted by MARTY on May 24, 2006, at 0:27:41
In reply to Re: Trouble urinating on various meds? » Phillipa, posted by Larry Hoover on May 23, 2006, at 19:10:26
Could treating the urinary problem improve the sexual one ?
... Genital Anesthesia ?
... Impotence ?
... Anorgasmia ?
I think my Pdoc talk me about BETHANECHO.Marty
Posted by CEK on May 24, 2006, at 13:40:17
In reply to Re: Trouble urinating on various meds?, posted by MARTY on May 24, 2006, at 0:27:41
I had this problem on Cymbalta 30mg and 60mg. I took it for 4 months. My case was not as severe as yours but I definitely had problems going and felt like I could not empty my bladder all the way. I am always drinking something, whether it's water, tea, diet coke,always got a drink in my hand and normally am in the bathroom an awful lot. On Cymbalta, I didn't even need to go to pee when I got up in the morning. It would take me 2-3 hours before I'd have to go. I also noticed that my urine was a dark yellow almost brownish color when it use to be clear.
Posted by Larry Hoover on May 24, 2006, at 17:27:21
In reply to Re: Trouble urinating on various meds? Reggie, posted by CEK on May 24, 2006, at 13:40:17
> I had this problem on Cymbalta 30mg and 60mg. I took it for 4 months. My case was not as severe as yours but I definitely had problems going and felt like I could not empty my bladder all the way. I am always drinking something, whether it's water, tea, diet coke,always got a drink in my hand and normally am in the bathroom an awful lot. On Cymbalta, I didn't even need to go to pee when I got up in the morning. It would take me 2-3 hours before I'd have to go. I also noticed that my urine was a dark yellow almost brownish color when it use to be clear.
If anyone else is displaying this symptom, this change in urine colour, on Cymbalta, they need to get off it. Permanent kidney damage can result from this, if left unchecked. Not meaning to be scary, but it is serious.
Lar
Posted by Reggie BoStar on May 24, 2006, at 19:09:42
In reply to Trouble urinating on various meds?, posted by Reggie BoStar on May 23, 2006, at 9:57:11
Hi All,
After being catheterized for the second time, my urologist put me on a therapeutic dose of Flomax which has helped quite a bit - at home, anyway. I still have trouble relaxing the muscles in public, but maybe that will go away with practice.Next month I go in for some kind of endoscope test to see what's going on with the prostate. They had some trouble getting past it with that second catheter, so much so that I demanded they remove the tube once my bladder was emptied. The pain was just too intense.
Right now my money is on the Flomax. It had better be, because my shrink wants to increase the Cymbalta from 30 to 60 mg. If that's the cause of all this, the Flomax may not help too much. Time will tell...
Posted by Phillipa on May 24, 2006, at 19:19:41
In reply to Re: Trouble urinating on various meds?, posted by Reggie BoStar on May 24, 2006, at 19:09:42
I have no idea how old you are but an enlarged protrate requires a doc to insert the catheter with a different type of cathether. Love Phillipa
Posted by Reggie BoStar on May 25, 2006, at 5:17:29
In reply to Re: Trouble urinating on various meds? » Reggie BoStar, posted by Phillipa on May 24, 2006, at 19:19:41
> I have no idea how old you are but an enlarged protrate requires a doc to insert the catheter with a different type of cathether. Love Phillipa
Hi Phillipa,
I'm 55, so some enlargement of the prostate is "normal". The problem with the second catheter is that they used the standard hose the first time around and did not use the smaller one until the second try. Still, it hurt like hell and I made them take it out once my bladder was empty.Today my Cymbalta dose goes from 30 to 60 mg/day. I'll soon find out if that's the problem. Thus far I don't have much to report on Flomax; it seems to help a little, but that could be a placebo effect. Fortunately I don't have to pay for the first batch, because it's a sample kit.
Take care,
Reggie BoStar
Posted by Larry Hoover on May 25, 2006, at 7:29:16
In reply to Re: Trouble urinating on various meds?, posted by Reggie BoStar on May 25, 2006, at 5:17:29
> > I have no idea how old you are but an enlarged protrate requires a doc to insert the catheter with a different type of cathether. Love Phillipa
> Today my Cymbalta dose goes from 30 to 60 mg/day. I'll soon find out if that's the problem. Thus far I don't have much to report on Flomax; it seems to help a little, but that could be a placebo effect. Fortunately I don't have to pay for the first batch, because it's a sample kit.
>
> Take care,
> Reggie BoStarReggie, I am seriously concerned that you are going ahead with this dose increase. Your doctor's orders are not gospel. How much adverse effects are required before you will question what is going on here?
Saw palmetto has entered Western medicine as an effective drug. Somehow, even doctors have begun to approve of a mere herb. There is no reason whatsoever to endure prostate enlargement.
Lar
Posted by Reggie BoStar on May 26, 2006, at 15:26:29
In reply to Re: Trouble urinating on various meds? » Reggie BoStar, posted by Larry Hoover on May 25, 2006, at 7:29:16
> > > I have no idea how old you are but an enlarged protrate requires a doc to insert the catheter with a different type of cathether. Love Phillipa
>
> > Today my Cymbalta dose goes from 30 to 60 mg/day. I'll soon find out if that's the problem. Thus far I don't have much to report on Flomax; it seems to help a little, but that could be a placebo effect. Fortunately I don't have to pay for the first batch, because it's a sample kit.
> >
> > Take care,
> > Reggie BoStar
>
> Reggie, I am seriously concerned that you are going ahead with this dose increase. Your doctor's orders are not gospel. How much adverse effects are required before you will question what is going on here?
>
> Saw palmetto has entered Western medicine as an effective drug. Somehow, even doctors have begun to approve of a mere herb. There is no reason whatsoever to endure prostate enlargement.
>
> Lar
>Hey Larry,
That's a good idea. I hadn't thought of Saw Palmetto. I'm going to give it a shot to see what happens. How long does it typically take to start working?Thanks,
Reggie BoStar
Posted by Dr. Bob on May 26, 2006, at 18:04:34
In reply to Re: Trouble urinating on various meds? » Larry Hoover, posted by Reggie BoStar on May 26, 2006, at 15:26:29
> That's a good idea. I hadn't thought of Saw Palmetto...
Sorry to interrupt, but I'd like to redirect follow-ups regarding Saw Palmetto to Psycho-Babble Health. Here's a link:
http://www.dr-bob.org/babble/health/20060330/msgs/649030.html
Thanks,
Bob
Posted by ed_uk on May 28, 2006, at 13:58:13
In reply to Re: Trouble urinating on various meds?, posted by Reggie BoStar on May 25, 2006, at 5:17:29
Hi
Cymbalta causes urinary retention because it inhibits the reuptake of norepinephrine. This leads to overstimulation of alpha-1 receptors in the the urinary tract. The result is an inability to urinate because the outlet of the bladder is so tightly contracted.
Tamsulosin (Flomax) is a selective alpha blocker. It relaxes the muscles which constrict the outlet of the bladder. Since you're taking Cymbalta, a high dose might be necessary. The standard dose of Flomax is 400 mcg per day. My guess is that you might need 800 mcg.
Alfuzosin (Uroxatral) is another effective alpha blocker. If Cymbalta has elevated your blood pressure, doxazosin (Cardura) might be a good alternative because it reduces BP as well as facilitating urination.
Take care
Ed
Posted by ed_uk on May 28, 2006, at 14:00:09
In reply to Re: Trouble urinating on various meds? Reggie, posted by CEK on May 24, 2006, at 13:40:17
Hi CEK
That's bad news. Please consult your doctor ASAP.
Ed
This is the end of the thread.
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