title: Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis.
abstract: BACKGROUND
  Antimuscarinics should be used with caution in older adults with overactive bladder (OAB) due to anticholinergic adverse events (AEs). Systematic reviews and meta-analyses (SRMAs) have analyzed safety-related outcomes but have not specified risk in the elderly, the population at highest risk for AEs. The aim of this review is to explore and evaluate AEs and treatment discontinuations in adults 65 or older taking antimuscarinics for OAB.
  
  
  METHODS
  Keywords were searched in MEDLINE, EMBASE, SCOPUS, and Cochrane Central Register for Controlled Trials. Randomized controlled trials (RCTs) along with sub-analyses and pooled analyses that compared antimuscarinics to placebo or another antimuscarinic were performed in February 2015. Studies assessing AEs or treatment discontinuations in a population of adults 65 or older were included. The Jadad Criteria and McHarm Tool were used to assess the quality of the trials.
  
  
  RESULTS
  A total of 16 studies met the inclusion criteria. Eighty AEs and 27 reasons for treatment discontinuation were described in the included studies and further explored. Anticholinergic AEs were more common in antimuscarinics compared to placebo. Incidence of dizziness, dyspepsia, and urinary retention with fesoterodine, headache with darifenacin, and urinary tract infections with solifenacin were significantly higher compared to placebo. Treatment discontinuation due to AEs and dry mouth were higher in the antimuscarinics when compared to placebo in older adults.
  
  
  CONCLUSIONS
  Treatment for overactive bladder using antimuscarinics in adults aged 65 or older resulted in significant increases in risk for several AEs compared to placebo including anticholinergic and non-anticholinergic AEs.
authors.affiliation: St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, United States. Electronic address: scott.vouri@stlcop.edu.
authors.forename: Scott Martin
authors.initials: SM
authors.lastname: Vouri
authors.affiliation: University of Kentucky, College of Pharmacy, 789 S. Limestone, Lexington, KY, United States.
authors.forename: Clark D
authors.initials: CD
authors.lastname: Kebodeaux
authors.affiliation: Univeristy of Illinois at Chicago, College of Pharmacy, 833 South Wood Street, Chicago, IL, United States.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Stranges
authors.affiliation: St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, United States.
authors.forename: Besu F
authors.initials: BF
authors.lastname: Teshome
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D028761:Withholding Treatment
chemical_list: D018727:Muscarinic Antagonists
keywords: Adverse events; Antimuscarinics; Elderly; Meta-analysis; Overactive bladder; Systematic review