Lesson of the week: Oxybutynin and cognitive dysfunction

Delirium following fesoterodine treatment for urgency incontinence in an 89-year old man

“…[15][16][17] In this case, hallucinations stopped seven days after stopping fesoterodine. As the half-life for 5-HMT is approximately eight hours, complete elimination would be expected after 40-56 hours (5-7 half-life).…”

The paediatric neuropathic bladder

“…Of significant concern are the suggested cognitive side-effects, particularly as these children represent a neurologically vulnerable cohort. [8] For children who are not controlled by anticholinergic therapy and clean intermittent catheterisation, other options need to be explored, as discussed below. These patients may have persistent hydronephrosis, new renal scarring, vesico-ureteric reflux, persistent incontinence or UTIs.…”

Cognition and fatigue in multiple sclerosis: Potential effects of medications with central nervous system activity

“…Second generation antihistamines that have very limited effects on cognitive function in healthy subjects were also considered to have no CNS activity. Subjects taking CNS-active medications with mild or infrequent side effects on cognition or fatigue (e.g., SSRIs [21], beta-blockers [20], anticholinergics for bladder dysfunction [13,16]) or drugs with more consistent or more marked negative effects on cognitive function or fatigue (e.g., benzodiazepines, tricyclic antidepressants) were assigned to a second group.…”

“…Many other drugs used by people with MS may negatively affect cognitive function as assessed by controlled trials in healthy control subjects, patient groups, or animals. This list includes tricyclic antidepressants, anticholinergics, first generation antihistamines, baclofen, beta-blockers, amantadine, selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines [6][7][11][12][13][14][15][16][17][18][19][20][21]. On the other hand, methylphenidate and related drugs (modafinil) improve some cognitive functions in healthy subjects [11,[22][23].…”