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24-10-2011 | Endocrinology | Article

Common medications linked to LUTS


Free abstract

MedWire News: Use of commonly prescribed medications including bronchodilators and antidepressants could account for up to 10% of the prevalence of lower urinary tract symptoms (LUTS) in men, report researchers.

If a causal relationship can be shown in future studies, the finding underscores the importance of assessing concomitant medication use in the differential diagnosis of LUTS, they remark, in the Archives of Internal Medicine.

"While benign prostatic hyperplasia (BPH) is the most common cause, the etiology of LUTS is multifactorial," write Stephen Jacobsen (Kaiser Permanente Southern California, Pasadena, USA) and co-investigators.

Several categories of prescription drugs are known to worsen LUTS through effects on detrusor muscle and urinary sphincter function, so it is important to quantify the association between common medication use and LUTS, they say.

The researchers distributed a questionnaire among 63,579 men from the California Men's Health Study, aged 45-69 years, over a 1-year period (2002-2003) to assess medication use and LUTS prevalence, and linked responses with their electronic health records.

Jacobsen and colleagues examined pharmacy records for dispensation of antidepressants, antihistamines, bronchodilators, nonurinary anticholinergenics, sympathomimetics, and diuretics.

LUTS was defined using the American Urological Association Symptom Index (AUAS), with a score of 0-7 indicating mild symptoms and a range of 8-35 indicating moderate-to-severe symptoms.

Results showed that the prevalence of LUTS increased with age, with up to 10% of men aged 70-74 years reporting severe symptoms (AUAS score of 20 or higher).

Medication use also increased significantly with age, says the research team, with the highest rise seen in diuretic use, from 8% to 23% of participants aged 45-49 years to 70-74 years, respectively.

After adjustment for geographic region, age, and race/ethnicity, Jacobsen et al found that bronchodilators and antidepressants had the strongest associations with LUTS, increasing the relative risk for the condition by a respective 22% and 39%.

After grouping men according to whether they had BPH (n=14,215 men had BPH), significant associations were more common between medications (sympathomimetics, diuretics, and antidepressants in particular) and LUTS among men without the prostate disorder.

Use of any of the studied medications was associated with a 29% increase in the relative risk for LUTS, which was attenuated slightly (28%) after accounting for presence of BPH.

In all, antihistamines, bronchodilators, diuretics, and antidepressants accounted for approximately 1%, 2%, 3%, and 4% of LUTS, respectively, remark the researchers. This is in comparison with the 29% of LUTS known to be accounted for by BPH, they add.

"Evolving treatment guidelines should consider common medication use and modify drug treatment to reduce the burden of LUTS without additional medications or invasive therapy," the team concludes.

By Sarah Guy

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