International Journal of Gerontology 10 (2016) 188
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International Journal of Gerontology
journal homepage: www.ijge-online.com
Letter to the Editor
Urinary Retention Related to Herbal Remedies in a Female Geriatric
Patient*
To the Editor,
Urinary retention (UR) is the inability to pass urine through
the urethra. Unnoticed UR can lead to acute renal failure. Herbal
products are being applied for the treatment of various diseases.
However, safety data are still lacking. We present a 69-year-old
woman with UR and acute renal failure due to herbal medicine use.
The patient was admitted to the emergency service with com-
plaints of mild suprapubic discomfort, voiding difculty, nausea,
vomiting, dry mouth, and overow urinary incontinence (UI).
The patient was using valsartan and amlodipine for hypertension;
no other medication was taken by her. The patient was using two
different herbal products, Saint Johns wort (SJW) and black hen-
bane (BH), in the past 2 weeks for mild depression. Vital signs
were normal. The only positive nding on physical examination
was suprapubic distension without guarding, which led to a sus-
picion of UR. Clear and yellow urine (1800 mL) was obtained after
urinary catheterization. Serum creatinine and urea levels were
3.4 mg/dL and 102 mg/dL, respectively. UR and acute renal failure
were diagnosed. Herbal remedies and valsartan was ceased; only
amlodipine was given for hypertension. Renal function and daily
urine output were followed. Serum creatinine and urea levels
returned to normal gradually. Extensive clinical and laboratory eval-
uations were performed in order to reveal the cause of UR. Urinary
tract infection was excluded by urinary analysis and culture. Under-
activity of the destructor muscle was found in urodynamic investi-
gation. Intermittent self-catheterization was suggested to the
patient. However, on follow up, normal micturition resumed and
the need for catheterization disappeared. We could not show an
organic, infective, and metabolic cause of UR at the end of the eval-
uation. The recently consumed herbal products BH and SJW were
suspected to cause UR because of their effects on the bladder.
In this patient, it is possible that the anticholinergic property of
BH and the seratonergic effect of SJW might have caused UR, espe-
cially given the absence of concomitant medications or medical
comorbidities. We applied the Naranjo adverse drug reaction prob-
ability scale for both herbal products. The scores were 4 (possible)
and 1 (doubtful) for BH and SJW, respectively. SJW had low scores in
the Naranjo criteria. However, drugs are evaluated individually, and
drugedrug interactions are not taken into account in the Naranjo
criteria. In our case, we suspected an herbaleherbal interaction.
Besides sympathetic and parasympathetic systems, neurotrans-
mitters such as serotonin, dopamine, and opioids are thought to be
*
Conicts of interest: All contributing authors declare that they have no conicts
of interest.
http://dx.doi.org/10.1016/j.ijge.2016.04.002
1873-9598/Copyright 2016, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
involved in the control of micturition. The anticholinergic effect of
BH is more prominent on muscarinic receptors than on other
cholinergic receptors. The anticholinergic effect of this plant on
the bladder has been shown previously.1
Serotonin has an inhibitory effect on the bladder, and SJW in-
hibits the reuptake of serotonin.2,3 In addition, UI related to selec-
tive serotonin reuptake inhibitors such as escitalopram was
reported.4
In our case, both herbal products were involved in UI due to
their different effects on the bladder. It is important to be reminded
that herbaleherbal interactions can be a cause of patient's symp-
toms in clinical practice in addition to potential adverse reactions
to herbal products or herbaledrug interactions.
References
1. Alizadeh A, Moshiri M, Alizadeh J, et al. Black henbane and its toxicityda
descriptive review. Avicenna J Phytomed. 2014;4:297e311.
2. Matsumoto-Miyai K, Yoshizumi M, Kawatani M. Regulatory effects of 5-hy-
droxytryptamine receptors on voiding function. Adv Ther. 2015;32(Suppl 1):
3e15.
3. Russo E, Scicchitano F, Whalley BJ, et al. Hypericum perforatum: pharmacokinetic,
mechanism of action, tolerability, and clinical drug-drug interactions. Phytother
Res. 2014;28:643e655.
4. Trombetta D, Garrett K, Harrison M. Escitalopram-associated acute urinary
retention. Consult Pharm. 2013;28:661e669.
Ahmet Yalcin*, Kamile Silay
Geriatric Medicine Department, Ataturk Training and
Research Hospital, niversiteler District,
ankaya, Ankara, Turkey
Ebru Uz
Nephrology Department, Ataturk Training and Research Hospital,
niversiteler District, ankaya, Ankara, Turkey
Teslime Atli
Geriatric Medicine Department, Guven Hospital, Kavaklidere,
ankaya, Ankara, Turkey
*
Correspondence to: Dr Ahmet Yalcin, Ug ur Mumcu Caddesi,
69/9 Gazi Osman Pasa, Ankara 06500, Turkey.
E-mail addresses: ahyalu06@gmail.com,
ahmetemreyalcin@hotmail.com (A. Yalcin).
14 November 2015
Available online 27 July 2016