[Oral anticholinergics in overactive bladder].
Behavioural therapy and anticholinergics are the mainstays in the treatment of symptoms of overactive bladder in patients with idiopathic and neurogenic detrusor overactivity; they are the first-line treatment. Oxybutynin, propiverine, tolterodine and trospium chloride as well as the "newcomers" solifenacin and darifenacin are comparable in regards to their efficacy. However, based on different pharmacokinetics and pharmacodynamics with different resorption velocity, different metabolisation and different CNS penetration, the profile of adverse events is different, qualitatively and quantitatively. Substances that are resorbed slowly or available as slow-release formulations are tolerated better. Lipophilic anticholinergics which pass the blood-brain barrier may compromise cognitive functions, especially in geriatric patients, who are already on cholinesterase inhibitors due to memory disorders. The following article gives an overview of the anticholinergics currently prescribed in patients with symptoms of overactive bladder with special attention to the influence of pharmacokinetics/pharmacodynamics on the adverse events profile including possible CNS side effects.
Madersbacher
H
H
Neuro-Urologische Ambulanz, LKH-Univ.-Klinik, Anichstrasse 35, A-6020 Innsbruck, Austria. helmut.madersbacher@tilak.at
D000284:Administration, Oral; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000145:classification; D002986:Clinical Trials as Topic; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced; D006801:Humans; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000145:classification / Q000150:complications / Q000517:prevention & control*
D018680:Cholinergic Antagonists