Impact of medication on quality of life

Medications are designed to enhance a patient's quality of life, but many can cause adverse side effects. These effects may negatively impact well-being and, in some cases, contribute to developing new health conditions. For example, nocturia is a side effect of some drugs that, if not properly managed,  can lead to more severe complications.

What is nocturia?

Nocturia is a condition where a person frequently wakes up at night to urinate. It affects both men and women equally but becomes more common and increases with age. Nocturia is not a disease itself, it is a symptom of underlying health issues 

Approximately 50 million adults are affected, but only a small percentage receive proper treatment.

In adults above 65 years old, 25% wake up to urinate more than twice per night, leading to sleep deprivation.¹

Other causes of nocturia aside from medication include;

• Urinary tract infection (UTI)
• Excessive fluid intake, alcohol, caffeine, especially after dinner
• Age-related structural and functional change,s e.g. decreased bladder capacity
• Underlying medical conditions like diabetes, chronic heart failure, and chronic kidney disease
• Changes in daytime pattern of antidiuretic hormone(ADH) secretion²

How is urine produced and regulated?

Urine is produced in the kidneys, which have different compartments where this process occurs.  Substances containing nitrogenous wastes, salt, ions, and excess water enter the glomerulus, where they are filtered. Essential substances like glucose, some water, and certain ions are reabsorbed into circulation, while the impurities pass into the renal tubules, where they contribute to urine formation. The urine then flows through the urinary tract and is eventually excreted.

The volume and concentration of urine are regulated by a hormone called antidiuretic hormone(ADH), which helps the body retain water when needed.³

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A 7-8-hour good night’s sleep is recommended for adults; sleep time less than this can lead to decreased mental and physical function.

Research has shown that the most common cause of sleep disturbance is Nocturia. This sleep disturbance can lead to:

• Low work productivity
• Poor quality of life
• Fatigue, may increase the risk of accidents in drivers
• Falls and fractures, especially in older adults⁴                                                                                                      

Medications that can cause nocturia

These medications can worsen nocturnal alongside other causes. They include:

Diuretics

These are drugs that are used to treat excessive water retention in the body(edema) and are sometimes combined with antihypertensive medications.

There are different classes of diuretics, including;

• Loop diuretics (e.g., furosemide)
• Thiazide diretics (e.g., hydrochlorothiazide)

Loop diuretics work by blocking the Na-k-2Cl transporter, which is responsible for the reabsorption of water and sodium in the kidneys. This leads to increased excretion of water and sodium, resulting in frequent urination.

How to reduce nocturia in patients on diuretics

One way to reduce nocturia in patients taking diuretics is to take the medication  5-6 hours before bedtime or before 6 pm.to allow time for excess fluid to be excreted earlier in the day.

Antihypertensive drugs and their nocturnal effects

Antihypertensive medications are used to manage high blood pressure. Some drug classes have a stronger association with nocturnal effects, particularly nocturia. These include:

• Calcium channel blockers(CCB): Among antihypertensive drugs, CCBs are more commonly linked to nocturia
• Angiotensin-converting enzyme inhibitors(ACE): These drugs may contribute to nocturnal effects, though to a lesser extent than CCBs
• Angiotensin receptor blockers (ARB): Like ACE inhibitors, ARBs may also have some nocturnal impact but are generally less associated with nocturia

Calcium channel blockers cause nocturia more compared to some other antihypertensive drugs due to their effects on fluid retention and peripheral edema, which can lead to nocturnal diuresis.⁵

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Antidepressant drugs are prescribed to treat anxiety and depression, while antipsychotic drugs are used to treat conditions such as schizophrenia.

Some of the classes of drugs involved are:

•  Selective serotonin reuptake inhibitors(SSRIs) and serotonin-norepinephrine reuptake inhibitors(SNRIs) may contribute to urological side effects, including noctural disturbance⁶
• Tricyclic antidepressants(TCAs) are known to cause urinary adverse effects such as nocturnal enuresis

Other medications with nocturnal effects:

• Lithium: Commonly used to treat bipolar disorder, lithium can affect kidney function, potentially leading to increased nighttime urination

Management of nocturia

1. Patient’s assessment and diagnosis

The evaluation of nocturia begins with a thorough medical history and medication review to determine the causes. The diagnostic tests may include a urinalysis to check for infections and abnormalities and an ultrasound of the urogenital system to assess structural and functional issues.

2. Medication adjustments

Managing nocturia may involve modifying medication regimens, including dose adjustments and continuous monitoring. To reduce the side effects of drugs causing nocturia, alternative drugs can be used. It is also important to optimize medication timing, for example, diuretics should preferably be taken in the morning to reduce nighttime urination.

3. Lifestyle modification

Healthy sleep habits: Establishing a regular sleep routine can help manage nocturia-related sleep disturbances.

Fluid management: Reducing fluid intake in the evening, especially caffeine and alcohol, can help minimize nighttime urination.

4. Patient support and education

Educating patients about their condition and treatment options is essential.  Adherence to prescribed medications and lifestyle modifications can improve outcomes. Open communication with healthcare providers ensures better management through individualized treatment plans and necessary adjustments..

Summary

The medications help improve the quality of life for individuals with nocturia, but they may also have side effects, including worsening urinary symptoms. To minimize these effects, personalized treatment plans, close monitoring, and lifestyle modifications are essential.

FAQs

What is the main cause of nocturia?

There is no specific cause of nocturia. It can be triggered by factors such as excessive fluid intake, caffeine, alcohol, certain medications, and underlying medical conditions like diabetes or bladder disorders.

What medication increases urination?

Medications that can increase urination include calcium channel blockers, lithium, diuretics, etc.

How can I reduce frequent urination at night?

Nocturia can be managed by adjusting medication timing, limiting fluid intake in the evening, and avoiding caffeine and alcohol before bedtime.

Is nocturia gender specific?

No, it is not; it can affect all genders.

Does drinking water help with nocturia?

No drinking water, especially during bedtime, can worsen nocturia, especially for those taking medications that could increase urination.