Combined antimuscarinics for treatment of neurogenic overactive bladder.
Antimuscarinic drugs are the first line pharmacotherapy for overactive bladder, but they are not always effective to achieve complete continence. Nevertheless in some patients urodynamic investigations reveal insufficient effects with continuing incontinence events even with dose optimization. The aim of this study is to evaluate the effect of association of Oxybutynin chloride, Trospium chloride and Solifenacin succinate administered orally for a minimum of 12 weeks in subjects with suprasacral spinal cord injury with urge-incontinence, urodynamicproven neurogenic detrusor overactivity dysfunction and detrusor-external sphincter dyssynergia to improve level of continence, reduce the risks of urologic complications and enhance QOL. This study was a randomized, double blind, controlled, balanced-parallel-groups investigation of orally administed Oxybutynin in addition to Trospium chloride in the first group and Oxybutynin in addition to Solifenacin in the other group. A total of 12 patients with neurogenic detrusor overactivity and clean intermittent catheterization were allocated into two treatment groups: 5 mg tablet of Oxibutinin and 20 mg tablet of Trospium Chloride were administered respectively 3 times a day and 4 times a day in the first group (Group A). 5 mg tablet of Oxibutinin and 10 mg tablet of Solifenacin were administered respective 3 times a day and once daily in the second group (Group B). In both group of patients we found a significant decrease in incontinence episodes, with an improvement of bladder compliance, bladder capacity and volume voided. Side effects were higher in patients of group B, but in generally well tolerated. In conclusion, a combined antimuscarinic treatment might be a right option for patients affected by neurogenic bladder refractory to previous antimuscarinic monotherapy, and might slow down or delay other more invasive treatments.
IRCCS, S.Maugeri Foudation, Department of Neurology Neurorehabilitation and Spinal Unit, Cassano Murge, Italy.
R
R
Nardulli
E
E
Losavio
M
M
Ranieri
P
P
Fiore
G
G
Megna
R G
RG
Bellomo
G
G
Cristella
M
M
Megna
D000328:Adult; D001561:Benzilates / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D009662:Nortropanes / Q000008:administration & dosage; D011812:Quinuclidines / Q000008:administration & dosage; D000069464:Solifenacin Succinate; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics
D001561:Benzilates; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D009662:Nortropanes; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; C003330:trospium chloride; C005419:oxybutynin; D000069464:Solifenacin Succinate