Urinary Retention and Stevens-Johnson Syndrome Risks with Medications

Qianyoujie, urinary retention, Stephen-Johnson syndrome?

Since elementary school, through middle school and into college, I have been unable to urinate in public if there are others around.
I have had a pathological fear of urinating and need to ensure that no one is in the restroom before I can go.
As a result, I often experience severe urinary retention.

1.
A urologist diagnosed me with bladder weakness and poor bladder contraction.
The doctor mentioned that I might need to start taking Cymbalta (duloxetine).
Could this lead to urinary retention? I noticed that the medication leaflet seems to mention this possibility.
2.
I would like to ask the doctor about the Cymbalta leaflet, which states that it could cause potentially fatal Stevens-Johnson syndrome.
How likely is this? Thank you, doctor.

POPO346074, 30~39 year old female. Ask Date: 2020/09/20

Dr. Wang Zhenyang reply Psychiatry

Hello,
The package insert for Cymbalta does indeed mention these two side effects:
5.6 Severe Skin Reactions: The use of Cymbalta may lead to severe skin reactions, including Erythema Multiforme and Stevens-Johnson Syndrome (SJS).
The reported incidence of SJS associated with Cymbalta exceeds that of the general population (1-2 cases per million person-years).
It is generally accepted that the reporting rate may be underestimated, as adverse reactions may not be fully reported.
If a patient develops blisters, exfoliative rashes, mucosal erosions, or any other symptoms of an allergic reaction with an unknown cause, Cymbalta should be discontinued.
5.15 Urinary Hesitancy and Retention: Cymbalta is a medication that can affect urethral resistance.
If a patient experiences symptoms of urinary hesitancy while taking Cymbalta, the possibility of a correlation between these symptoms and the medication should be considered.
Post-marketing experience has reported cases of urinary retention.
Some cases of urinary retention have been associated with the use of Cymbalta, requiring hospitalization and/or catheterization.
However, the incidence is very low, so whether to use this medication should be discussed with your physician.
Wishing you health and happiness,
Dr.
Wang Zhenyang, Attending Physician and Director
Department of Community Psychiatry, Taoyuan Psychiatric Hospital, Ministry of Health and Welfare
71 Longshou Street, Taoyuan District, Taoyuan City, 330
TEL: 03-3698553 ext 2027
FAX: 03-3699498

Reply Date: 2020/09/20

More Info

Understanding urinary retention and the risks associated with medications like Duloxetine (known as Cymbalta) and the potential for Stevens-Johnson Syndrome (SJS) is crucial for anyone considering these treatments, especially in the context of pre-existing urinary issues.

Urinary Retention and Duloxetine
Urinary retention is a condition where an individual is unable to completely empty their bladder. This can lead to discomfort, increased risk of urinary tract infections, and other complications. Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is commonly prescribed for depression, anxiety, and certain types of chronic pain. However, it is important to note that one of the side effects of Duloxetine can be urinary retention.
The mechanism behind this side effect relates to how Duloxetine affects neurotransmitters in the body. By increasing serotonin and norepinephrine levels, it can influence the autonomic nervous system, which controls bladder function. Specifically, Duloxetine may increase urethral resistance, making it more difficult to urinate. For individuals with pre-existing bladder issues, such as bladder weakness or poor contraction strength, this can exacerbate urinary retention symptoms.

In your case, where you have been diagnosed with bladder weakness, the introduction of Duloxetine could potentially worsen your condition. It is essential to discuss these concerns with your healthcare provider. They may consider alternative medications or additional treatments to manage your urinary symptoms effectively while addressing your mental health needs.

Stevens-Johnson Syndrome (SJS) Risk
Stevens-Johnson Syndrome is a rare but serious condition that can occur as a reaction to certain medications. It is characterized by severe skin reactions, including blistering and peeling, and can affect mucous membranes, leading to complications in various organ systems. The risk of SJS associated with Duloxetine is noted in the medication's prescribing information, although the incidence is relatively low compared to the general population.

The reported incidence of SJS with Duloxetine is higher than that of the general population, but it is still considered rare. The symptoms of SJS typically begin with flu-like symptoms followed by painful red or purplish skin that blisters and peels. If you experience any signs of a severe skin reaction, such as blistering, peeling, or mucosal involvement, it is critical to seek immediate medical attention and discontinue the medication.

Conclusion and Recommendations
Given your history of urinary retention and the potential side effects of Duloxetine, it is crucial to have an open dialogue with your healthcare provider. Discuss your concerns about urinary retention and the risk of SJS in detail. Your provider may suggest monitoring strategies, alternative medications, or additional treatments to mitigate these risks.

In managing your mental health and urinary symptoms, a multidisciplinary approach may be beneficial. This could involve collaboration between your psychiatrist and a urologist to ensure that both your mental health and urinary health are adequately addressed.
Always remember, never hesitate to voice your concerns about side effects or medication interactions with your healthcare provider. Your safety and well-being should always be the priority in any treatment plan.

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