Antidepressants for urinary incontinence

Examples

Generic Name	Brand Name
duloxetine	Cymbalta
imipramine hydrochloride	Tofranil

This medicine 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 can help control stress incontinence. Studies show that duloxetine reduces the number of times women have stress incontinence.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 if they 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 on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

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 medicines for urinary incontinence, talk to your doctor about the following:

• Can your incontinence be treated with behavioral or exercise therapy before trying medicines? 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 doctor have in treating incontinence? Some doctors do not realize the impact that urinary incontinence can have on a person's life and may disregard your concerns.
• Could any of the medicines you are taking for another condition be causing your incontinence? Some medicines (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:	Sandy Jocoy, RN	Last Updated: September 17, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Avery L. Seifert, MD - Urology
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