A randomized, double-blind, placebo controlled crossover trial of nimodipine in older persons with detrusor instability and urge incontinence.
OBJECTIVE
We evaluated the efficacy of nimodipine, a dihydropyridine calcium channel blocker that relaxes vascular and nonvascular smooth muscle, for geriatric urge incontinence.


METHODS
A randomized, double-blind, placebo controlled crossover trial of 30 mg. nimodipine twice daily for 3 weeks in older persons with detrusor instability and chronic urge incontinence was done. A total of 86 participants with a mean age of 73.4 years were randomized. The primary outcome was the number of incontinent episodes, as measured by the self completion of a 5-day voiding record. Secondary outcomes included the impact of urinary incontinence on quality of life measured with a modified incontinence impact questionnaire (mIIQ) and symptoms, as measured by the American Urological Association (AUA) symptom score.


RESULTS
A total of 76 (88.4%) participants completed the study. There was no significant difference in the number of incontinent episodes with nimodipine versus placebo, which included a difference of 0.03 incontinent episodes during a 5-day period (p =0.98, 95% confidence interval -2.7 to 2.8). Scores on the mIIQ and the AUA symptom score were not significantly different with nimodipine versus placebo (p = 0.07 and 0.22, respectively). Regardless of initial treatment, participants had improvement with time, that is a period effect, of incontinent episodes (p <0.0001), mIIQ scores (p = 0.0002) and AUA symptom score values (p <0.0001).


CONCLUSIONS
Treatment of geriatric urge incontinence with 30 mg. nimodipine twice daily did not result in a significant improvement of incontinent episodes, mIIQ scores or AUA symptom scores.
Naglie
Gary
G
Divisions of General Internal Medicine, University Health Network, the Geriatrics Program, Toronto Rehabilitation Institute, the Clinical Epidemiology and Health Care Research Program (University Health Network Unit), Canada.
Radomski
Sidney B
SB
Brymer
Chris
C
Mathiasen
Karen
K
O'Rourke
Keith
K
Tomlinson
George
G
D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000503:physiopathology; D009553:Nimodipine / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000503:physiopathology; D014549:Urinary Incontinence / Q000188:drug therapy*; D014563:Urodynamics
D002121:Calcium Channel Blockers; D009553:Nimodipine