Update on the role of anticholinergic drug therapy in the management of overactive bladder.
OBJECTIVE
To review the published literature and describe the pathophysiology and management of overactive bladder (OAB), with emphasis on the comparative efficacy and adverse event profiles of anticholinergic agents approved for the management of OAB symptoms and evaluation of their place in therapy.


METHODS
A MEDLINE search of English language literature that addresses the pathophysiology and management of OAB symptoms. The references in identified articles were evaluated for additional relevant articles. Drug Topics' Red Book was referenced for cost comparisons, and package inserts were used for specific drug and dosing information.


METHODS
Human studies that presented efficacy and safety data with respect to anticholinergic medications in the treatment of OAB were selected.


METHODS
Studies were abstracted to identify key characteristics with respect to efficacy and safety in OAB, in particular anticholinergic side effects, with the greatest weight given to studies that compared two or more anticholinergic medications.


RESULTS
Epidemiologic studies have shown that the unpredictable and bothersome symptoms associated with OAB occur in approximately 16% of the worldwide adult population. Conservative management of OAB should include a combination of pharmacologic and nonpharmacologic interventions that have been found to improve outcomes when used in appropriately selected patients. Although long recognized as the most effective pharmacotherapy for OAB, anticholinergic agents have been associated with poor tolerability attributable to anticholinergic adverse events. New medications, formulations, and drug delivery systems have been developed with the goal of achieving effective treatment with improved tolerability.


CONCLUSIONS
Among these agents, extended-release and transdermal formulations have improved tolerability while retaining at least comparable efficacy. More research is needed regarding other routes of administration and new drug entities that specifically target the pathologic mechanisms involved in OAB.
Ruscin
J Mark
JM
Department of Clinical Pharmacy and Center on Aging, University of Colorado Health Science Services, Denver 80262, USA. mark.ruscin@uchsc.edu