Acute Urinary Retention Associated with Increased Dose of Atomoxetine in a Child: A Case Report

Abstract

Acute urinary retention associated with increased dose of atomoxetine in a child: a case report Urinary side effects of atomoxetine are extremely rare, especially in children. We report the presentation of acute urinary retention in an 8-year-old boy with attention deficit hyperactivity disorder (ADHD). To the best of our knowledge, this is the first case of a school-aged child experiencing urinary retention due to an increased dose of atomoxetine. We propose that noradrenergic systems in the urinary tract, possibly precipitated by a higher than usual initial dose of atomoxetine, may have been over-activated. Moreover, it may be suggested that urethral smooth muscles become more sensitive to alpha-adrenergic receptor stimulation before puberty.

Probable Genitourinary Adverse Events Associated With Atomoxetine in an Adult Male: A Case Report

“…2 Several case reports align with the findings of this pooled analysis, which are described in Table 1. [3][4][5][6][7][8] One case describes urinary hesitancy following atomoxetine initiation with quick resolution of symptoms upon discontinuation of the medication in a 41-yearold man also taking fluoxetine, a CYP 2D6 inhibitor. 3 Three cases describe urinary retention in children and adolescents.…”

“…3 Three cases describe urinary retention in children and adolescents. [4][5][6] All of these cases describe symptom onset quickly followed atomoxetine initiation or dosing increases and resolution shortly after discontinuation. [3][4][5][6] Two additional case reports document onset of spontaneous ejaculation both with and without orgasmic sensation following atomoxetine initiation in young males not taking other medications.…”

“…[4][5][6] All of these cases describe symptom onset quickly followed atomoxetine initiation or dosing increases and resolution shortly after discontinuation. [3][4][5][6] Two additional case reports document onset of spontaneous ejaculation both with and without orgasmic sensation following atomoxetine initiation in young males not taking other medications. 7,8 Atomoxetine increases norepinephrine by inhibiting its reuptake, leading to an increased sympathetic response, potentially describing the mechanism of urinary hesitancy or retention.…”

“…7,8 Atomoxetine increases norepinephrine by inhibiting its reuptake, leading to an increased sympathetic response, potentially describing the mechanism of urinary hesitancy or retention. [3][4][5] Urinary hesitancy can be described in part by a regulatory dysfunction of the sympathetic and parasympathetic pathways controlling the bladder and related muscles involved with micturition. Sympathetic activation leads to bladder filling and micturition inhibition, while parasympathetic activation leads to bladder emptying and micturition.…”

“…Data from clinical trials and case reports suggests this is a common symptomatic timeline and that risks for genitourinary adverse events are higher for males compared to females. [2][3][4][5][6][7][8] Limitations to our report are that the milky, white-colored discharge was not analyzed and confirmed to be semen, and that we did not specifically ask the patient if discharge was associated with an orgasmic sensation, as reported elsewhere. 7 Clinicians should be aware of the possible genitourinary adverse events of atomoxetine and educate patients on this risk.…”