title: Will the evolution of overactive bladder delivery systems increase patient compliance?
abstract: The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.
authors.affiliation: New York University Langone Medical Center New York, NY.
authors.forename: Nirit
authors.initials: N
authors.lastname: Rosenblum
references.citation: Eur Urol. 2002 Jun;41(6):588-95
references.pmid: 12074774
references.citation: J Urol. 2009 Apr;181(4):1764-72
references.pmid: 19233423
references.citation: Rev Urol. 2009 Winter;11(1):1-6
references.pmid: 19390669
references.citation: Eur Urol. 2004 Apr;45(4):420-9; discussion 429
references.pmid: 15041104
references.citation: Int Urol Nephrol. 2002;34(1):43-9
references.pmid: 12549638
references.citation: J Manag Care Pharm. 2008 Apr;14(3):291-301
references.pmid: 18439051
references.citation: Int J Clin Pract. 2009 Apr;63(4):560-7
references.pmid: 19348029
references.citation: Int J Clin Pract. 2005 Aug;59(8):931-7
references.pmid: 16033615
references.citation: Urology. 2006 Apr;67(4):657-64
references.pmid: 16618554
references.citation: Curr Urol Rep. 2008 Nov;9(6):465-71
references.pmid: 18947511
references.citation: Clin Ther. 2006 Sep;28(9):1247-72
references.pmid: 17062299
references.citation: J Urol. 2002 Aug;168(2):580-6
references.pmid: 12131314
references.citation: Curr Med Res Opin. 2005 Jan;21(1):71-80
references.pmid: 15881477
references.citation: Urology. 2003 Aug;62(2):237-42
references.pmid: 12893326
references.citation: BJU Int. 2006 Feb;97(2):400-3
references.pmid: 16430654
references.citation: Urology. 2003 Jan;61(1):37-49
references.pmid: 12559262
references.citation: J Urol. 2007 Sep;178(3 Pt 1):978-83; discussion 983-4
references.pmid: 17632131
references.citation: Clin Pharmacokinet. 2001;40(3):227-35
references.pmid: 11327200