Antidepressants for urinary incontinence

Examples

Generic Name	Brand Name
duloxetine	Cymbalta
imipramine hydrochloride	Janimine, Tofranil

This medication is usually taken as pills or liquid (orally).

How It Works

Duloxetine is an antidepressant called a "selective serotonin and norepinephrine reuptake inhibitor." It changes how the brain uses certain brain chemicals. How it helps with bladder control is not yet known.

Imipramine is a tricyclic antidepressant, but it has anticholinergic side effects. This means that it relaxes the smooth muscle of the bladder. It also causes the muscles at the bladder neck to contract.

Use of these antidepressants for urinary incontinence is an unlabeled use of the medicines. This means that they are approved by the U.S. Food and Drug Administration (FDA) for another medical use, but not for urinary incontinence.

Why It Is Used

Duloxetine may be prescribed for stress incontinence.

Imipramine may be prescribed for:

• Urge incontinence.
• Stress incontinence.
• Mixed urge and stress incontinence.

How Well It Works

Duloxetine is the one antidepressant that has shown promise for treating stress incontinence in women.¹

Imipramine is not a well-studied incontinence treatment. It is not known as a highly effective treatment for urinary incontinence. But it may be worth trying if other medicines don't work or cause side effects.

Side Effects

The side effects of duloxetine can include:

• Upset stomach, vomiting.
• Constipation or diarrhea.
• Heartburn.
• Poor appetite.
• Dry mouth.
• Cough.
• Sweating or night sweats.
• Blurred vision.
• Dizziness.
• Extreme tiredness.
• Weakness, muscle pain, or cramps.
• Changes in sexual desire or ability.

The side effects of imipramine can include:

• Sleepiness.
• Dry mouth.
• Blurred vision.
• Urinary retention.
• Constipation.
• Paralysis of the intestines (paralytic ileus).
• Abnormal heartbeat (arrhythmia).

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide risk. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children, who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Imipramine increases the depressive effects of alcohol. Avoid alcoholic beverages during imipramine therapy.

Using imipramine may increase the skin's sensitivity to the sun. Protect yourself from sun exposure by using additional sunscreen while taking imipramine.

When taking an antidepressant, avoid driving or operating machinery until you know how the medicine affects you. It could make you drowsy.

In men, imipramine may cause urinary retention.

Before taking medications for urinary incontinence, talk to your health professional about the following:

• Can your incontinence be treated with behavioral or exercise therapy before trying medications? Behavioral or exercise therapy, such as bladder training or pelvic floor (Kegel) exercises, is noninvasive, can be done at home, is inexpensive, has no side effects, and does not limit future therapy options if it is not successful.
• How much experience does your health professional have in treating incontinence? Some health professionals do not realize the impact that urinary incontinence can have on a person's life and may disregard your concerns.
• Could any of the medications you are taking for another condition be causing your incontinence? Some medications (especially diuretics) cause the body to produce greater amounts of urine, which may contribute to incontinence problems. Take them when you will easily be able to get to a restroom.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Kathe Gallagher, MSW	Last Updated September 22, 2006
Medical Review:	Martin Gabica, MD - Family Medicine Avery L. Seifert, MD - Urology
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