Urinary flow and urinary symptoms in elderly males exposed to either escitalopram or duloxetine

Abstract

Objective:

To profile the effects of escitalopram with duloxetine on urinary flow rate and symptoms in elderly males aged 55–75 years.

Research design and methods:

This was an open, randomised pilot study. A total of 34 male volunteers with no existing urinary symptoms were randomised: 17 to escitalopram 10 mg once daily and 17 to duloxetine 60 mg once daily for 16 days. Doses were then tapered to 5 mg and 30 mg, respectively for 14 days. Subjects measured their urinary flow at home using a Urospec device for 48 hours pre-dose, immediately after the first dose, at 2 weeks and 5 days after stopping treatment.

Main outcome measures:

The primary variable was the maximum urinary flow rate (Q_max). Secondary variables were time to maximum flow rate (TQ_max) and mean flow rate (Q_m). The percentage of voided volume voided when the maximum flow was reached (VQ_max), average voided volume (V_v) and urinary symptoms assessed using the American Urological Association symptom index were also measured.

Results:

Mean Q_max values increased from baseline in escitalopram-treated subjects and decreased in duloxetine-treated subjects. The maximum difference in treatment effect was observed after 2 days of treatment and was statistically significant (4.27 mL/sec, 95% CI 1.14–7.39, p = 0.009). Similar results were obtained with TQ_max. There were no significant differences between treatments in other urinary flow measures or urinary symptoms. Urinary flow measures reverted towards baseline values after stopping treatment. There were no treatment-related adverse events.

Conclusions:

The results of this small, pilot study suggest that duloxetine may cause a decline in urinary flow in elderly men. A larger study in patients with urinary flow symptoms would be required to determine the clinical relevance of these findings.

Key words::

• Duloxetine
• Elderly males
• Escitalopram
• Urinary flow

Transparency

Declaration of funding

Financial support for the study was provided as an unrestricted grant by Lundbeck A/S, Copenhagen, Denmark.

Declaration of financial and other relationships

A.W. and G.C. are directors of CPS Research, a company which has received financial and research support from many pharmaceutical companies including Lundbeck A/S and Eli Lilly. A.W. and G.C. planned and conducted the study, and prepared the initial draft of the manuscript with Dr Susan Downie. All authors have read and approved the final manuscript. Peer reviewers may receive honoraria for their review work. The peer reviewers have disclosed no relevant financial interests.

Acknowledgements

We are grateful to Professor Ian Ford and staff of the Robertson Centre for Biostatistics, University of Glasgow for statistical support.