Antimuscarinic Pharmacotherapy for Overactive Bladder

Current pharmacotherapy of overactive bladder

“…Contrary to this hypothesis, the network meta-analytic study by Kessler et al showed similar urinary tract related adverse events between antimuscarinics and placebo (66). The current understanding is such that the dose range used for beneficial effects in OAB is lower than that needed to produce a significant reduction in the voiding contraction (70). Consistent with this, the use of antimuscarinics in association with an alpha-blocker in men with BPH and a moderately enlarged prostate (up to 75g) has been shown to be safe even in patients with a post-void residual of up to 150mL (71).…”

“…Contraindications for the use of antimuscarinics include urinary retention (including post--void residuals >150-200mL), gastric retention, decreased gastrointestinal motility conditions, and narrow-angle glaucoma. The distinction between open-angle and narrow-angle glaucoma is essential and may warrant referral to an ophthalmologist (70). i -Urinary retention and antimuscarinics: The inhibitory effect of antimuscarinics on detrusor contraction could worsen bladder emptying and contribute to urinary retention.…”

Comparison between efficacy of solifenacin and oxybutynin for the treatment of overactive bladder in women.

“…Various anti-muscarinic drugs such as tolterodine, solifenacin, oxybutynin, trospium chloride, propiverine and fesoterodine have been widely used since long due to their proven efficacy, tolerability and stability. 15,16 The basic mechanism of action of these drugs is antagonism of muscarinic (M3) receptors located in the smooth muscles of bladder. Though, anti-muscarinics are commonly in use for treating OAB patients but which drug is more effective, is not yet clear.…”