title: Antimuscarinics for the treatment of overactive bladder: understanding the role of muscarinic subtype selectivity.
abstract: OBJECTIVE
  Antimuscarinic agents appear to exert their therapeutic activity in overactive bladder (OAB) via blockade of the M(3) muscarinic receptor subtype. Antimuscarinics are broadly similar in efficacy, but their safety and tolerability profiles vary, which may reflect differences in muscarinic receptor selectivity profiles.
  
  
  METHODS
  This review of available literature aims to determine whether antimuscarinic agents with greater M(3) selectivity have clinical advantages over less selective drugs.
  
  
  RESULTS
  Antimuscarinic agents differ widely in their propensity to cause cognitive and cardiovascular (CV) effects, which appear mainly to be related to differences in their relative selectivity for binding to non-M(3) receptors, including M(1) receptors in the brain and cardiac M(2) receptors.
  
  
  CONCLUSIONS
  Cognitive and CV effects are especially pertinent for the OAB patient who tends to be older with various comorbidities and is often taking multiple medications. Hence, it is important to consider the risk/benefit balance of antimuscarinic agents when selecting OAB treatment.
authors.affiliation: Department of Gynecology and Obstetrics, Aalborg Sygehus Nord, 9000 Aalborg, Denmark. glavind@dadlnet.dk
authors.forename: Karin
authors.initials: K
authors.lastname: Glavind
authors.forename: Michael
authors.initials: M
authors.lastname: Chancellor
mesh_terms: D001812:Blood-Brain Barrier; D002319:Cardiovascular System / Q000187:drug effects*; D003071:Cognition / Q000187:drug effects*; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011976:Receptors, Muscarinic / Q000145:classification / Q000187:drug effects*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D018727:Muscarinic Antagonists; D011976:Receptors, Muscarinic