What medications can cause increased urination. How do diuretics affect urine production. Why do antihistamines lead to urinary retention. Can decongestants impact bladder function. Which antidepressants may cause urinary incontinence. Do calcium channel blockers affect urination habits. How does lithium influence urine output.

Understanding the Link Between Medications and Urinary Changes

Many individuals experience changes in their urination patterns, often without realizing that their medications could be the culprit. Frequent urination, urinary retention, and incontinence are common side effects of various over-the-counter and prescription drugs. Understanding these effects is crucial for managing one’s health and comfort.

Brooke D. Hudspeth, PharmD, an associate professor and chief practice officer at the University of Kentucky College of Pharmacy, explains that certain medications can lead to urinary retention and “overflow incontinence.” This occurs when the bladder cannot effectively contract and expel urine, resulting in residual urine in the bladder. Other medications may interfere with urethral function, causing leakage or increased frequency of urination.

Diuretics: The Intentional Urine Increasers

Diuretics, commonly known as “water pills,” are designed to increase urination. They work by enhancing the excretion of water and sodium from the body through the kidneys. While beneficial for treating conditions like high blood pressure, swelling, heart failure, and liver or kidney disorders, diuretics can disrupt sleep patterns due to frequent nighttime urination.

How to Manage Diuretic-Induced Frequent Urination?

If you’re experiencing sleep disturbances due to diuretic use, consider these strategies:

• Consult your doctor about adjusting the timing of your medication
• Take diuretics earlier in the day to minimize nighttime bathroom trips
• Monitor your fluid intake, especially in the evening
• Use a bedside commode to reduce the need for walking to the bathroom at night

Tricyclic Antidepressants and Urinary Incontinence

Tricyclic antidepressants can interfere with the normal urination process. These medications may affect both the ability of the urethra to remain closed and the bladder’s capacity to contract effectively. As a result, some individuals taking tricyclic antidepressants may experience urinary leakage or incontinence.

What Are the Mechanisms Behind Antidepressant-Induced Incontinence?

Tricyclic antidepressants can impact urinary function through several mechanisms:

1. Relaxation of the bladder muscles, reducing contractility
2. Interference with nerve signals controlling urination
3. Alteration of the urethral sphincter tone
4. Changes in urine production and concentration

Antihistamines: Allergy Relief with a Urinary Twist

Antihistamines, particularly Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine), can affect bladder function. Jason Varin, PharmD, an assistant professor at the University of Minnesota College of Pharmacy, explains that these medications can relax the bladder’s smooth muscle, impairing its ability to empty completely.

How Do Antihistamines Affect Urination Patterns?

The effects of antihistamines on urination include:

• Relaxation of bladder muscles, leading to incomplete emptying
• Faster refilling of the bladder due to residual urine
• More frequent urges to urinate
• Potential urinary retention in some cases

Decongestants: Nasal Relief with Bladder Consequences

Decongestants like Sudafed (pseudoephedrine) and Suphedrine PE (phenylephrine) work by constricting blood vessels to reduce nasal congestion. However, this effect extends to other muscles in the body, including those involved in urination. The bladder’s sphincter and, in individuals with male genitalia, the prostate can be affected, making urination more difficult.

What Are the Urinary Side Effects of Decongestants?

Common urinary issues associated with decongestant use include:

• Difficulty initiating urination
• Weak urine stream
• Sensation of incomplete bladder emptying
• Increased urinary frequency due to residual urine

Calcium Channel Blockers and Urinary Symptoms

Calcium channel blockers, commonly prescribed for hypertension, have been associated with urinary symptoms, particularly in older adults. A study revealed that 60 percent of older adults seeking medical attention for incontinence were taking medications with urinary side effects, with calcium channel blockers being among the most common.

How Do Calcium Channel Blockers Impact Urination?

The effects of calcium channel blockers on urinary function include:

1. Relaxation of the bladder muscles, potentially leading to incomplete emptying
2. Alteration of bladder contractility
3. Changes in urinary urgency and frequency
4. Possible exacerbation of existing urinary issues

Mood Stabilizers: Balancing Mental Health and Urinary Function

Lithobid (lithium), a mood-stabilizing medication used to treat bipolar disorder, can have significant effects on urinary function. While it’s considered a lifesaver for many individuals with bipolar disorder, lithium is known to have numerous side effects, including those related to urination.

What Urinary Changes Can Lithium Cause?

Lithium can impact urinary function in several ways:

• Increased urine production (polyuria)
• Frequent urination (pollakiuria)
• Alterations in kidney function and urine concentration
• Potential development of diabetes insipidus in some cases

Managing Medication-Induced Urinary Changes

If you’re experiencing urinary changes while taking any of these medications, it’s essential to communicate with your healthcare provider. They can help determine whether the benefits of the medication outweigh the urinary side effects and explore potential alternatives or management strategies.

What Steps Can You Take to Address Medication-Related Urinary Issues?

Consider the following approaches:

1. Keep a urinary diary to track frequency, volume, and any associated symptoms
2. Discuss dosage adjustments or alternative medications with your doctor
3. Implement lifestyle changes, such as timed voiding or pelvic floor exercises
4. Explore the use of protective undergarments or bladder training techniques
5. Stay well-hydrated, but consider timing your fluid intake

The Importance of Medication Review and Communication

Regular medication reviews with your healthcare provider are crucial, especially if you’re experiencing urinary changes. These reviews can help identify potential drug interactions or cumulative effects that may be contributing to your symptoms.

How Can You Prepare for a Medication Review?

To make the most of your medication review:

• Bring a complete list of all medications, including over-the-counter drugs and supplements
• Document any changes in urinary patterns or other side effects you’ve noticed
• Prepare questions about your medications and their potential impacts on urinary function
• Be open to discussing alternative treatments or management strategies

Balancing Medication Benefits and Urinary Side Effects

While urinary changes can be bothersome, it’s important to remember that the medications causing these effects are often crucial for managing other health conditions. The decision to continue, adjust, or change a medication should be made in consultation with your healthcare provider, weighing the benefits against the side effects.

What Factors Should Be Considered When Evaluating Medication-Induced Urinary Changes?

When assessing the impact of medications on urinary function, consider:

1. The severity and frequency of urinary symptoms
2. The importance of the medication for managing your primary health condition
3. Available alternative treatments or medications
4. Your overall quality of life and daily functioning
5. The potential risks of untreated urinary symptoms

Understanding the relationship between medications and urinary changes is crucial for maintaining both your health and quality of life. By staying informed, communicating openly with your healthcare provider, and actively participating in your treatment decisions, you can work towards finding the right balance between managing your health conditions and minimizing urinary side effects.

Remember that everyone’s response to medications can vary, and what works for one person may not be suitable for another. Personalized care and regular follow-ups with your healthcare team are essential in navigating the complex interplay between medications and urinary function.

As medical knowledge continues to evolve, new strategies for managing medication-induced urinary changes may emerge. Staying informed about the latest developments in pharmacology and urology can help you make more informed decisions about your health and treatment options.

Ultimately, the goal is to find a treatment plan that effectively manages your health conditions while minimizing disruptive side effects. With patience, open communication, and a willingness to explore various options, most individuals can achieve a satisfactory balance between medication efficacy and urinary comfort.

10 Medications That May Cause Increased Urination

Maybe you’ve noticed that you’re rushing to the restroom lately. Or you’re waking up in the middle of the night to go. Perhaps you’re needing to take way more breaks at work to pee.

There are many potential causes of frequent urination. They include, but are not limited to, an increase in water intake, a urinary tract infection, or onset of a new disease such as diabetes, as the Mayo Clinic notes.

It’s worth asking yourself: “Have I started a new medication lately?”

That gotta-go impulse is a relatively common side effect of various drugs available over-the-counter and by prescription. “Many medications can lead to urinary retention and something we call ‘overflow incontinence,’ which is when the bladder is not able to contract and expel urine effectively, leaving urine in the bladder,” says Brooke D. Hudspeth, PharmD, an associate professor and the chief practice officer at the University of Kentucky College of Pharmacy in Lexington. Other meds may interfere with the function of the urethra and lead to leakage or cause the bladder to quickly fill up with urine and make you pee more frequently.

Whether you’re on diuretics (“water pills”) to reduce your blood pressure, a decongestant to clear your sinuses, or a mood-stabilizing medication for bipolar disorder, here are some common medications that may be causing you to urinate more.

1. Diuretics

The point of a diuretic is to increase urination. “All diuretics work to increase the excretion of water and sodium from the body through the kidneys,” explains Dr. Hudspeth. This is helpful in treating conditions such as high blood pressure, swelling, heart failure, and liver or kidney disorders, she says. But peeing more can disturb your sleep if you’re waking up multiple times to go to the bathroom. Hudspeth recommends asking your doctor if you can take diuretics earlier in the day to avoid cutting into your sleep.

RELATED: 8 Common Medications That May Cause Dehydration

2. Tricyclic Antidepressants

Peeing is normally a well-orchestrated process. When your bladder fills up (and is holding that urine) the urethra — the tube connected to the bladder that empties urine — needs to stay shut to keep it all in until you decide you’re ready to go to the bathroom, says Hudspeth. What’s more, your bladder has to be able to contract to expel the urine into the urethra. Tricyclic antidepressants may interfere with both processes, and lead to leakage, also called urinary incontinence.

3. Antihistamines

For some people, sneezes can cause a little urine to leak. But this may also be due to an antihistamine that you’re taking to control allergy symptoms. The most common offenders are Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine), says Jason Varin, PharmD, an assistant professor at the University of Minnesota College of Pharmacy in Minneapolis. “The bladder is a smooth muscle that fills up with urine. When it reaches a certain level and is full, it sends signals to the brain that it’s time to urinate,” he explains. Trouble is, certain antihistamines can relax the bladder, blunting its ability to push out urine. In the end, there is still some urine left in your bladder, which means it will fill up again faster and send that “gotta pee” signal to your brain sooner.

RELATED: 10 Common Food and Medication Interactions to Avoid

4. Decongestants

The good thing about decongestants such as Sudafed (pseudoephedrine) and Suphedrine PE (phenylephrine) is that they temporarily quell nasal congestion by constricting blood vessels, ultimately lessening swelling. But that effect happens to other muscles, too, including the bladder’s sphincter, says Dr. Varin. “This is the on-off valve of the bladder, and these medications may make the bladder constrict so that it’s more difficult for urine to pass from the bladder,” he says. In people with male genitalia, “decongestants can also constrict the prostate, which surrounds the urethra, also making it more difficult to pass urine,” Varin adds.

5. Calcium Channel Blockers

Among older adults who went to the doctor because of incontinence, 60 percent were taking medications that had urinary symptoms as a side effect, per a previous study. Among the most common medications they were taking? Calcium channel blockers. This class of medication, used to treat hypertension, may cause the bladder to relax and affect its ability to empty properly, says Hudspeth.

RELATED: What Does Burning or Painful Urination (Dysuria) Mean?

6. Mood Stabilizers

Lithobid (lithium) is a mood-stabilizing medication used to treat bipolar disorder, notes the National Alliance on Mental Illness (NAMI). “For some individuals, lithium is the best treatment, considered a lifesaver for some, even though it has a host of likely side effects,” says Varin. One of those potential side effects is excessive urination and thirst, which may affect up to 70 percent of individuals who take lithium long term, per a paper published December 2016 in the International Journal of Bipolar Disorders. While this side effect may be annoying, it can also be dangerous if the dose you’re taking is too high. “Lithium doses that are too high for an individual can lead to changes in the kidney and to a form of diabetes that impacts the function of the kidneys,” explains Varin. That condition is called diabetes insipidus, which is not the same as type 1 or 2 diabetes. “Diabetes insipidus has to do with the kidney’s ability to regulate fluids and reabsorb water properly, resulting in an increased urination of mostly fluids. In turn, that creates what some describe as an endless thirst,” he says. It can cause electrolyte and fluid imbalances, so talk to your doctor if you have these side effects.

7. Antipsychotics

Versacloz, FazaClo, and Clozaril (clozapine) are antipsychotic medications that treat schizophrenia, and can be a particularly important medication for patients who have suicidal thoughts, according to the U.S. National Library of Medicine. Frequent urination is one possible side effect because it can cause diabetes insipidus, says Hudspeth. One of the main complications of diabetes insipidus is dehydration, which has symptoms including thirst, dry skin, fatigue, dizziness, confusion, and nausea, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Talk to your doctor if you’re on this medication and experience increased urination.

RELATED: 10 Ways to Keep Your Bladder Healthy and Happy

8. Some Medications for Type 2 Diabetes

The newer medications for type 2 diabetes, a class called sodium-glucose cotransporter-2 (SGLT2) inhibitors work by “increasing the amount of glucose or blood sugar your kidneys excrete and pass through urine, which takes fluid with it,” says Varin. Some good news: There was a concern that SGLT2 inhibitors would also increase the risk of urinary tract infection (one symptom of UTI is a persistent urge to urinate, per the Mayo Clinic), but newer research has failed to find that connection, suggests the February 2020 issue of Clinical Kidney Journal.

9. Alpha Blockers

Alpha blockers, such as Cardura (doxazosin), Minipress (prazosin), and Hytrin (terazosin), are another class of medications used to treat high blood pressure. They work by relaxing blood vessels to allow for adequate blood flow — but they may also relax the muscles of the urethra and cause urinary incontinence, says Hudspeth. According to the Mayo Clinic, these drugs are often used in combination with other blood pressure lowering drugs, such as diuretics, so there’s a chance that increased urination issues could be caused by one or both these medications.

RELATED: The Possible Benefits of Metformin for Type 2 Diabetes and Other Health Conditions

10. Opioids

Opioids are drugs that can be prescribed by doctors to treat pain, such as OxyContin (oxycodone) or Vicodin (hydrocodone), morphine, and methadone, according to the Centers for Disease Control and Prevention (CDC). These are highly addictive, and one in four people who are treated long-term with these drugs experience opioid addiction, says the CDC. Clearly, that is the chief concern. But a lesser side effect is urinary problems, according to an article published in January 2017 in the International Journal of Molecular Sciences. Opioids can impair your bladder’s ability to empty by interfering with proper bladder contraction. Your doctor may be able to prescribe other pain control medications if you’re experiencing side effects.

If you have any concerns about your medication or new onset of urinary changes, speak to a primary care provider for an evaluation and medical guidance.

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Urinary Tract and Kidney Warnings on Nonprescription Products

US Pharm. 2014;39(8):12-15. 

Pharmacists are in a unique position with regard to counseling about OTC products. They can explore the various warnings and precautions on a product’s label to help patients decide when a product is inappropriate and a physician should be consulted, a process called pharmacist-assisted self-care triage. Many nonprescription products carry warnings related to the urinary tract, and knowledge of those products and the rationale for the warnings can help pharmacists provide the highest level of care.

Prostate Warnings

An enlarged prostate is a fact of life for males, especially as they reach the age of 40 years and beyond; by the age of 80 years, at least 90% of men suffer from benign prostatic hyperplasia (BPH). ¹ Because of its location surrounding the urethra, an enlarged prostate usually inhibits urine flow.² Several classes of nonprescription products are contraindicated in men with BPH, because they contain alpha-adrenergic agonists and/or anticholinergics.

Alpha-adrenergic agents such as pseudoephedrine, phenylephrine, and ephedrine all act to increase sphincter strength at the neck of the bladder, inhibiting a patient’s ability to urinate.³ For this reason, most nonprescription medications with these ingredients warn against use if the patient has decreased urination due to an enlarged prostate. If the patient were to ignore the warnings and use the product anyway, it is possible that acute urinary retention could result, requiring emergency catheterization to relieve the distended bladder.⁴

Alpha-adrenergic agonists (i.e., sympathomimetics) are found in numerous products marketed for the common cold, flu symptoms, and sinus problems, as well as in single-entity oral nasal decongestant products (e. g., Sudafed, Sudafed PE), topical nasal decongestants (e.g., Afrin, Neo-Synephrine), asthma products (e.g., Primatene), hemorrhoid products (e.g., several Preparation H products), and some ophthalmic drops (e.g., Opcon-A, Naphcon-A, Visine-A).⁵

Nonprescription medications with anticholinergic effects could also inhibit bladder flow.⁶ The target group for this labeling includes the large number of products containing first-generation antihistamines, such as chlorpheniramine, clemastine, cyclizine, dimenhydrinate, diphenhydramine, doxylamine, meclizine, pheniramine, and pyrilamine. Some products containing them are safe and effective for treating allergic rhinitis and/or the common cold, such as Chlor-Trimeton, Tavist, and Benadryl. Others help relieve occasional insomnia (e.g., Nytol, Unisom). They are also the single ingredient in products for preventing and treating motion sickness (e.g., Dramamine, Bonine, Marezine) and are a component of ophthalmic vasoconstrictor/antihistamine drops (e. g., Opcon-A, Naphcon-A, Visine-A). They are also found in numerous combination products marketed for the common cold and related conditions. All of these products will carry the required prostate warning.⁵

Kidney Disease

A number of nonprescription products carry a vague warning against use if the patient has “kidney disease.” The spectrum of kidney disease is exceedingly broad, but the label was apparently kept nonspecific so that all patients with any type of kidney disease would be alerted to seek professional advice before using them.

Antacid product labels must display the kidney disease warning if they contain >50 mEq of magnesium or >25 mEq of potassium per maximum recommended daily dose. The warning is intended to prevent hypermagnesemia and hyperkalemia in patients with a reduced ability to eliminate these ions through urination. Such products include Maalox Advanced Regular Strength Liquid and Alka-Seltzer Gold.⁵

Certain histamine₂ (H₂)-blockers carry the kidney disease precaution, as they are primarily eliminated renally. ⁷ These include Pepcid AC Maximum Strength and Zantac 150.⁵ The lower-dose formulations of both of these products are not required to carry a kidney disease precaution.

Laxatives containing magnesium also carry a warning against use in patients with kidney disease. Like antacids, laxatives must carry a kidney disease warning if they contain >50 mEq of magnesium per maximum recommended daily dose. This would apply to Phillips’ Milk of Magnesia and magnesium citrate products such as Citroma. Another laxative with a kidney disease warning is polyethylene glycol (PEG) 3350 (e.g., MiraLAX). The concern is apparently that PEG might cause volume depletion.⁸

Oral analgesics may carry a warning against use with kidney disease. For the same reasons mentioned above (i.e., avoiding hypermagnesemia), the precaution is found on magnesium salicylate-containing analgesics, such as Doan’s Pain Reliever.⁵

One of the more inclusive labeling changes in regard to kidney disease was proposed by the FDA in a 2006 issue of the Federal Register and finalized in 2009. ^9,10 The FDA stated that it had received serious adverse event reports regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and renal toxicity. The agency affirmed that most healthy people who ingest NSAIDs for a limited time tolerate them well.⁹ However, the FDA went on to list a group of patients who are predisposed to adverse renal effects when taking NSAIDs. The possible sequelae are life-threatening nephro-toxicity, such as acute renal failure and serious fluid and electrolyte disorders. Patients more prone to this adverse effect include those with volume depletion, underlying kidney disease, congestive heart failure, liver dysfunction with ascites, and the elderly. Furthermore, use during the last trimester of pregnancy can induce significant neonatal nephrotoxicity.

In further discussion, the FDA explored the link between NSAIDs and nephrotoxicity.^9,10 For instance, a decrease in renal production of vasodilatory prostaglandins would lead to acute reduction in blood flow and glomerular filtration. These changes would be expected to cause fluid retention, edema, and elevated serum creatinine. Thus, a pronounced decrease in renal perfusion could cause renal failure.

As a result of its exhaustive investigation of this issue, the FDA now requires the kidney disease warning on all products containing aspirin, magnesium salicylate, ibuprofen, naproxen, and ketoprofen.¹⁰

Second-generation antihistamines carry a warning against self-use with kidney disease. The products include loratadine (e.g., Claritin), cetirizine (e.g., Zyrtec), and fexofenadine (e.g., Allegra 24HR).⁵

Kidney Stones

As of this writing, the only non-prescription products to carry a specific warning against use with kidney stones are oxybutynin transdermal patches (Oxytrol for Women) and orlistat (alli). Orlistat can induce oxalate nephropathy

and resultant renal stone disease.¹¹ Oxalate nephropathy is characterized as a “rare but serious adverse effect” of orlistat directly due to an increase in fat malabsorption, which is the mechanism by which orlistat helps with weight loss. ¹²

Limited Fluid Intake Due to Renal Disease

Patients with renal failure or any other condition that requires them to limit fluid intake should be cautious in the use of fiber-replacement products such as psyllium (e.g., Metamucil) and methylcellulose (e.g., Citrucel).⁵

Oxybutynin Transdermal System

The most extensive set of warnings related to the urinary tract on any nonprescription product label is found on oxybutynin transdermal system (Oxytrol for Women).¹³ The product is indicated only for overactive bladder in women, characterized by two or more of the following (lasting for 3 months or more): urinary frequency more than 8 times in 24 hours, urinary urgency, and/or urge incontinence. The label warns prospective purchasers that frequent urination may also be caused by a urinary tract infection (UTI), diabetes, early pregnancy, and other more serious conditions, all of which require a physician appointment. The label also points out various symptoms of UTI, any of which would require an immediate physician appointment, including pain or burning when urinating (perhaps accompanied by fever or chills), blood in the urine, unexplained pain in the lower back or side, and/or urine that is cloudy or foul-smelling. ¹³

Women are advised not to use Oxytrol if they only experience accidental urine loss when they cough, sneeze, or laugh, as those are characteristic of stress incontinence, which will not be alleviated by the product. Patients who have urinary retention are cautioned not to use the product. The patch is not to be used if the patient has kidney stones. Patients are advised to stop use and make a physician appointment if they are not able to empty the bladder.¹³

Suggesting Alternative Approaches

The pharmacist can suggest alternative therapeutic approaches for patients with urinary tract contraindications in some cases. Nasal congestion may be relieved by nasal strips such as Breathe Right, as they are safe for those with urinary compromise. Redness of the eye may be treated with single-entity ophthalmic drops (e.g., Visine), which do not carry prostate warnings. Allergic conjunctivitis may be treated with a single-entity ophthalmic antihistamine, such as Zaditor, as it is also free of urinary tract precautions. ⁵

Nonprescription antihistamines all carry urinary tract warnings: against use in patients with prostatic enlargement in the case of first-generation products, and against use in kidney disease in the case of second-generation products. Patients with allergic rhinitis can be advised to try cromolyn nasal spray (NasalCrom) or triamcinolone acetonide nasal spray (Nasacort Allergy 24HR). Neither carries a warning concerning the urinary tract.⁵

In regard to gastric products, patients may try such antacid ingredients as calcium carbonate (e.g., Tums) or bismuth subsalicylate (e.g., Pepto-Bismol). They may also try the lower dose versions of Pepcid and Zantac, neither of which carries a urinary tract warning. Further, none of the four currently available proton pump inhibitors (e.g., Prilosec OTC, Prevacid 24HR, Zegerid OTC, Nexium 24HR) carries a urinary tract-related label precaution, and may be recommended for the patient with frequent heartburn, as defined on the label of those products. ⁵

Acetaminophen is free of urinary tract warnings, and may be preferable for the patient with kidney disease. However, as with all nonprescription product counseling sessions, pharmacists should point out the numerous additional warnings and situations in which acetaminophen is contraindicated, such as with liver disease.⁵

PATIENT INFORMATION

Prostate Problems

The prostate is a male organ that circles the urinary outflow channel leading from the bladder. As men age, a large percentage of them develop a condition known as benign prostatic hyperplasia, or enlargement of the prostate. An enlarged prostate slowly restricts bladder outflow, making it difficult to urinate. Some nonprescription products can make it even harder to urinate, and the patient who takes them without reading and following the label may need to visit an emergency room to be catheterized so the bladder can be emptied.

These patients should first speak to their physician so the doctor can judge whether they might be able to use such a product in their particular situation. Products of concern include nasal decongestants (e.g., pseudoephedrine, phenylephrine, naphazoline), as found in such dosage forms as tablets, oral liquids, nasal sprays, and nasal drops. Nasal decongestants are also popular ingredients in combination products for the common cold, allergic rhinitis, sinus problems, and flu symptoms.

Some antihistamines are also hard on the prostate. They are found in products for the common cold and allergic rhinitis, motion sickness products, sleep aids, and some eye drops. Ingredients of concern include doxylamine, clemastine, cyclizine, meclizine, chlorpheniramine, diphenhydramine, dimenhydrinate, and pheniramine.

If you do not have a physician who can be consulted, you should ask your pharmacist. Pharmacists can often suggest therapeutic alternatives that would be risk-free for those with prostate enlargement.

Kidney Disease

Some nonprescription products are eliminated from your body via your urine. They include some antacids (products containing magnesium and/or potassium), other stomach medications (some products containing ranitidine or famotidine), some laxatives (those containing magnesium), and certain antihistamines (loratadine, cetirizine, and fexofenadine). If your body’s ability to eliminate these medications is compromised by kidney disease, the drug levels in your blood can endanger your health. Your physician should be consulted to make a decision about possibly lowering the dose on the label so you will be safe. Once again, your pharmacist can help you with therapeutic alternatives that do not present problems with kidney disease, when they are available.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of pain medication that can cause kidney damage, especially if you already have kidney disease. Examples include aspirin, magnesium salicylate, ibuprofen, naproxen, and ketoprofen. It is best to avoid NSAIDs completely and speak to your physician or pharmacist about safer alternatives.

Kidney Stones

If you have kidney stones, you should avoid taking the OTC weight-loss product alli (due to an increase in fat malabsorption). You should also not use Oxytrol for Women, a patch product for overactive bladder in women, because it might possibly cause urinary retention.

Limited Fluid Intake Due to Renal Disease

Some patients have kidney damage that forces them to limit their fluid intake to prevent fluid overload. If you have this problem, you should avoid nonprescription products that must be taken with a lot of fluid so you can get them down. This includes bowel regulation products containing psyllium and methylcellulose. 

REFERENCES

1. Enlarged prostate. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/article/000381.htm. Accessed June 20, 2014.

2. Prostate enlargement: benign prostatic hyperplasia. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/. Accessed June 20, 2014.

3. Stress incontinence. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/article/000891.htm. Accessed June 20, 2014.

4. Soyer T, Göl IH, Eroglu F, Cetin A. Acute urinary retention due to pseudoephedrine hydrochloride in a 3-year-old child. Turk J Pediatr. 2008;50(1):98-100.

5. Various products. www.drugstore.com. Accessed June 20, 2014.

6. Roehrborn CG. Acute urinary retention: risks and management. Rev Urol. 2005;7(suppl 4):S31-S41.

7. Ranitidine 150 mg. National Institutes of Health. http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=41453. Accessed June 20, 2014.8. Cohen LB, Kastenberg DM, Safdi AV. Current issues in clinical bowel preparation. Gastroenterol Hepatol. 2009;5(11 suppl 19):3-11.

9. FDA. Internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; proposed amendment of the tentative final monograph; required warnings and other labeling. Fed Regist. 2006;71(247):77314-77353.

10. FDA. Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Fed Regist. 2009;74(81):19385-19409.

11. Ahmed MH. Orlistat and calcium oxalate crystalluria: an association that needs consideration. Ren Fail. 2010;32(8):1019-1021.

12. Chaudhari D, Crisostomo C, Youngberg G. Acute oxalate nephropathy associated with orlistat: a case report with a review of the literature. Case Rep Nephrol. 2013;2013:124604. www.ncbi.nlm.nih.gov/pmc/articles/PMC3914170/. Accessed June 20, 2014.

13. Oxytrol for Women (oxybutynin transdermal system) package insert. Whitehouse Station, NJ: MSD Consumer Care, Inc; 2014.14. CDC. Prostate cancer. What are the symptoms? www.cdc.gov/cancer/prostate/basic_info/symptoms.htm. Accessed June 20, 2014.

15. Prostatitis—bacterial. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed June 20, 2014.

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How Allergy Medicine Can Lead to Alzheimer’s

Diana Tosepova

July 11, 15:36

During allergy season, many of us will turn to the first aid kit for relief. But antihistamines can negatively affect long-term health and even lead to dementia. Rambler will tell you more about this.

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Renowned doctor Alexander Myasnikov warned that antihistamines can trigger the development of Alzheimer’s disease.

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According to the expert, genetic predisposition, lack of exercise, overweight, smoking and diabetes, and taking certain medications, such as benzodiazepines, opioids, and even antihistamines, are risk factors for this disease.

Scientists around the world have been talking about the harmful effects of antihistamines for years. A report published in the journal JAMA Internal Medicine highlights the link between long-term use of anticholinergic drugs such as Benadryl and dementia. We know that anticholinergics can cause confusion and increase the risk of falling in the elderly.

Anticholinergics block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In other parts of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, overactive bladder control drugs, and drugs to relieve the symptoms of Parkinson’s disease.

A team led by Shelley Gray, a pharmacist at the University of Washington School of Pharmacy, tracked nearly 3,500 men and women aged 65 and over. Participants’ health was monitored for an average of seven years. During this time, 800 volunteers developed dementia. When researchers looked at the use of anticholinergic drugs, they found that people who took these drugs were more likely to develop dementia than those who did not. Moreover, the risk of dementia increased with cumulative dose. Taking anticholinergics for three years or more was associated with a 54% increased risk of dementia compared with taking the same dose for three months or less.

These studies are adding to the growing evidence that anticholinergics are not drugs that should be taken long-term if you want to keep a clear head in old age.

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The body’s production of acetylcholine decreases with age, so blocking its effects can be a double whammy for older people. Not surprisingly, problems with short-term memory, reasoning, and confusion top the list of side effects of anticholinergic drugs, which also include drowsiness, dry mouth, urinary retention, and constipation.

The University of Washington study is the first to include over-the-counter drugs.

Diseases and medicines, Alexander Myasnikov, Allergy, Dementia

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Frequently asked question: Can Benadryl hurt my dog?

For most dogs, the appropriate dosage of Benadryl is perfectly safe. After about an hour, it will begin to reduce symptoms such as skin rashes. Proper dosage is important because most Benadryl tablets are for humans. Some dogs may be quite small, so they need less Benadryl than a human.

The lethal dose (LD ₅₀ ) for diphenhydramine in dogs ranges from 24 to 30 mg/kg BW when administered intravenously, and death is attributed to neuromotor agitation and convulsions followed by respiratory failure and myocardial depression (16).

Common side effects associated with the use of Benadryl in dogs include: Drowsiness. Dry mouth. Urinary retention.
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Rare side effects include:

Official response. The general dose of Benadryl (diphenhydramine) is 2 to 4 mg/kg up to three times a day. If your dog weighs 25 pounds (11.3 kg), the dose of Benadryl will be 22.6 to 45.2 mg up to three times a day. Benadryl tablets are available in 25 and 50 mg dosages.

Benadryl may cause severe drowsiness, dry mouth or urinary retention in the dog, and potentially cause gastrointestinal disturbances such as diarrhea and/or vomiting. 1 In cats, it can cause the opposite of what it is used for – the so-called paradoxical effect – and you may see arousal.

Most diphenhydramine (Benadryl) tablets have a dose of 25mg, which would be an appropriate size for a 25lb dog. Smaller dogs will require you to cut or split these 25mg tablets. In this case, children’s Benadryl chewable tablets may be a good option.

This short-acting drug should wear off within 24 hours, although it may take longer to work in pets with liver or kidney disease.

You can give your dog Benadryl every eight to twelve hours, which is about two to three times a day. If you use the product frequently, it may lose effectiveness over time. In most cases, it is best to take medications before exposure to allergens.

The usual dosage is about 1 mg per pound two to three times a day. Veterinarians often recommend starting with half the dose to see how it calms the dog the first time. Also, pet parents should be aware that tablets and capsules are usually 25mg, but other sizes (such as 50mg) do exist.

Melatonin can be a great supplement for your dog. The sedative properties of melatonin make it an effective sedative for restless dogs.

The only way to safely euthanize a dog at home is the presence of a veterinarian or veterinarian. … If you want to put your dog to sleep at home, you should always check with your veterinarian.