The use of bladder antimuscarinics is very common in the elderly. However, recent
population-based studies that assessed the use of anticholinergics or bladder
antimuscarinics showed an increased risk of dementia when these drugs were used
for a prolonged period. Several of these population-based studies included
patients who used solifenacin, which is a bladder antimuscarinic released in
2005 with the prospect of being a more selective antimuscarinic for M3 receptors
(M3R), which could make it a safer drug when trying to avoid unwanted effects of
older bladder antimuscarinics such as oxybutynin, especially with regard to
changes in cognition. Since the various bladder antimuscarinics have distinct
pharmacological characteristics, such as in the ability to penetrate the
blood-brain barrier, in selectivity for muscarinic receptors, and in brain
efflux mechanisms, their effects on the central nervous system (CNS) may vary.
Solifenacin was the drug selected in this review, which aims to describe the
results of several articles published in recent years reporting the effects of
solifenacin on cognition or the risk of dementia development. Although
preclinical studies show that solifenacin can also act on brain M1 receptors
(M1R), short-term clinical studies have shown it to be safe for cognition.
However, there are no long-term randomized studies that prove the safety of this
drug for the CNS. Thus, until the safety of solifenacin has been established by
long-term studies, it seems advisable to avoid prolonged use of this drug in
elderly patients.
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