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Management of use of urinary antimuscarinics and alpha blockers for benign prostatic hyperplasia in older adults at risk of falls: a clinical review

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Key summary points

AbstractSection Aim

To review the current knowledge and the underlying pathophysiology of fall risk associated with the use of urinary antimuscarinics and alpha-blockers in older adults and help clinicians in (de-)prescribing urinary antimuscarinics and alpha-blockers.

AbstractSection Findings

Untreated overactive bladder and/or benign prostatic hyperplasia increase fall risk in older adults and so do urinary antimuscarinics and/or alpha-blockers. These drugs contribute to (or cause) falling through dizziness, somnolence, visual impairment, and orthostatic hypotension while they differ in these fall-related side effect profiles. While considering withdrawal of urinary antimuscarinics and alpha-blockers is recommended for older adults under high fall risk, physicians are frequently hesitant to deprescribe these drugs. There are practical resources and algorithms that guide and assist clinicians in deprescribing these drug groups.

AbstractSection Message

Comprehension of fall-related side effect profiles of antimuscarinics and alpha-blockers and clinical decision tools such as the STOPPFall withdrawal algorithm help prescribers in attaining rational decisions while (de-)prescribing.

Abstract

Purpose

We aimed to outline the existing information and the underlying mechanisms of risk of falls associated with the use of urinary antimuscarinics for overactive bladder (OAB) or alpha-blockers for benign prostatic hyperplasia (BPH) in older adults. In addition, we aimed to provide assistance to clinicians in decision-making about (de-)prescribing these drugs in older adults.

Methodology

Based on a literature search in PubMed and Google Scholar, we reviewed the literature, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in OAB and BPH in older patients. We discussed the use of bladder antimuscarinics and alpha-blockers, their potential side effects related to falls, and the deprescribing of these drugs in older adults.

Results

Urinary urgency or incontinence and lower urinary tract symptoms due to untreated OAB and BPH contribute to fall risk. On the other hand, the use of bladder antimuscarinics and alpha-blockers is also related to fall risk. They contribute to (or cause) falling through dizziness, somnolence, visual impairment, and orthostatic hypotension while they differ in their side-effect profiles regarding these problems. Falls are common and can cause a remarkable amount of morbidity and mortality. Thus, preventive measures should be taken to lower the risk. If the clinical condition allows, withdrawal of bladder antimuscarinics and alpha-blockers is recommended in fall-prone older adults. There are practical resources and algorithms that guide and assist clinicians in deprescribing these drug groups.

Conclusions

The decision to prescribe or deprescribe these treatments in patients at high risk of falls should be individualized. In addition to explicit tools that are helpful for clinical decision-making in (de-)prescribing these drugs, STOPPFall (a recently developed expert-based decision aid specifically aiming to prevent falls) is present to assist prescribers in attaining decisions.

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References

  1. Deandrea S, Lucenteforte E, Bravi F et al (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21:658–668

    Article  PubMed  Google Scholar 

  2. Al-Aama T (2011) Falls in the elderly: spectrum and prevention. Can Fam Physician 57:771–776

    PubMed  PubMed Central  Google Scholar 

  3. Chiara M, Gianluigi G, Pasquale A et al (2013) Unexplained falls are frequent in patients with fall-related injury admitted to orthopaedic wards: the UFO study (unexplained falls in older patients). Curr Gerontol Geriatr Res 2013:928603

    Article  PubMed  PubMed Central  Google Scholar 

  4. National Institute for Health and Care Excellence (NICE) (2015) Falls in older people

  5. Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61:37–49

    Article  PubMed  Google Scholar 

  6. Shaw C, Wagg A (2020) Overactive bladder in frail older adults. Drugs Aging 37:559–565

    Article  CAS  PubMed  Google Scholar 

  7. Thom D (1998) Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 46:473–480

    Article  CAS  PubMed  Google Scholar 

  8. Nakagawa H, Niu K, Hozawa A et al (2010) Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol 184:1413–1418

    Article  PubMed  Google Scholar 

  9. Jayadevappa R, Chhatre S, Newman DK et al (2018) Association between overactive bladder treatment and falls among older adults. Neurourol Urodyn 37:2688–2694

    Article  PubMed  Google Scholar 

  10. Wagg AS CL, Johnson T et al (2017) Incontinence in the frail elderly. In: Abrams P CL, Wagg A, Wein A (eds) Incontinence, 6th Edition

  11. Chuang CC, Yang E, Zou KH et al (2019) Health and functional status, health events, use of healthcare services and costs associated with overactive bladder among the medically complex vulnerable elderly in the US. Int J Clin Pract 73:e13207

    Article  PubMed  Google Scholar 

  12. Brown JS, Vittinghoff E, Wyman JF et al (2000) Urinary incontinence: does it increase risk for falls and fractures? Study of osteoporotic fractures research group. J Am Geriatr Soc 48:721–725

    Article  CAS  PubMed  Google Scholar 

  13. Szabo SM, Gooch KL, Walker DR et al (2018) The association between overactive bladder and falls and fractures: a systematic review. Adv Ther 35:1831–1841

    Article  PubMed  PubMed Central  Google Scholar 

  14. Josephson KLGD (2004) Key considerations when treating the older patient with symptoms of urinary frequency and urgency. Ann Long-Term Care 12:2

    Google Scholar 

  15. Green AR, Reifler LM, Boyd CM et al (2018) Medication profiles of patients with cognitive impairment and high anticholinergic burden. Drugs Aging 35:223–232

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kachru N, Holmes HM, Johnson ML et al (2021) Antimuscarinic use among older adults with dementia and overactive bladder: a Medicare beneficiaries study. Curr Med Res Opin 37:1303–1313

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sura S, Aparasu R (2019) PUK19 overactive bladder patients in the nursing homes: resident characteristics and treatment pattern. Value in Health 22:S384

    Article  Google Scholar 

  18. Wagg A (2018) Anticholinergics for overactive bladder in frail and medically complex older people: the case for. Drugs Aging 35:777–780

    Article  PubMed  Google Scholar 

  19. Boyle P, Napalkov P (1995) The epidemiology of benign prostatic hyperplasia and observations on concomitant hypertension. Scand J Urol Nephrol Suppl 168:7–12

    CAS  PubMed  Google Scholar 

  20. Committee AUAPG. 2003 AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 170: 530–547

  21. Parsons JK, Mougey J, Lambert L et al (2009) Lower urinary tract symptoms increase the risk of falls in older men. BJU Int 104:63–68

    Article  PubMed  PubMed Central  Google Scholar 

  22. Feldstein C, Weder AB (2012) Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens 6:27–39

    Article  PubMed  Google Scholar 

  23. Lavsa SM, Fabian TJ, Saul MI et al (2010) Influence of medications and diagnoses on fall risk in psychiatric inpatients. Am J Health Syst Pharm 67:1274–1280

    Article  PubMed  Google Scholar 

  24. Poon IO, Braun U (2005) High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 30:173–178

    Article  CAS  PubMed  Google Scholar 

  25. Bertaccini A, Vassallo F, Martino F et al (2001) Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. Eur Urol 40(Suppl 1):13–18

    Article  PubMed  Google Scholar 

  26. Lukacz ES (2021) Urgency urinary incontinence/overactive bladder (OAB) in females: Treatment. In. UpToDate

  27. Clinical Consensus Statement (2021) Association of anticholinergic medication use and cognition in women with overactive bladder. Female Pelvic Med Reconstr Surg 27:69–71

    Article  Google Scholar 

  28. Fogaing C, Mossa AH, Campeau L (2020) Are beta 3 adrenergic agonists now the preferred pharmacologic management of overactive bladder? Curr Urol Rep 21:49

    Article  PubMed  Google Scholar 

  29. From the American Association of Neurological Surgeons ASoNC, Interventional Radiology Society of Europe CIRACoNSESoMINTESoNESOSfCA, Interventions SoIRSoNS et al (2018) Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke. Int J Stroke 13: 612–632

  30. Kachru N, Holmes HM, Johnson ML et al (2020) Risk of mortality associated with non-selective antimuscarinic medications in older adults with dementia: a retrospective study. J Gen Intern Med 35:2084–2093

    Article  PubMed  PubMed Central  Google Scholar 

  31. Andersson KE (2017) On the site and mechanism of action of beta3-adrenoceptor agonists in the bladder. Int Neurourol J 21:6–11

    Article  PubMed  PubMed Central  Google Scholar 

  32. Griebling TL, Campbell NL, Mangel J et al (2020) Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4 randomized, placebo-controlled study (PILLAR). BMC Geriatr 20:109

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Nambiar AK, Bosch R, Cruz F et al (2018) EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 73:596–609

    Article  PubMed  Google Scholar 

  34. Lightner DJ, Gomelsky A, Souter L, Vasavada SP (2019) Diagnosis and treatment of overactive bladder (Non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol 202:558–563

    Article  PubMed  Google Scholar 

  35. Kistler KD, Xu Y, Zou KH et al (2018) Systematic literature review of clinical trials evaluating pharmacotherapy for overactive bladder in elderly patients: an assessment of trial quality. Neurourol Urodyn 37:54–66

    Article  PubMed  Google Scholar 

  36. Buser N, Ivic S, Kessler TM et al (2012) Efficacy and adverse events of antimuscarinics for treating overactive bladder: network meta-analyses. Eur Urol 62:1040–1060

    Article  CAS  PubMed  Google Scholar 

  37. Chapple C, Schneider T, Haab F et al (2014) Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency urinary incontinence episodes in patients with overactive bladder: results of the randomised, double-blind, placebo-controlled EIGHT trial. BJU Int 114:418–426

    CAS  PubMed  Google Scholar 

  38. Kaplan SA, Cardozo L, Herschorn S et al (2014) Efficacy and safety of fesoterodine 8 mg in subjects with overactive bladder after a suboptimal response to tolterodine ER. Int J Clin Pract 68:1065–1073

    Article  CAS  PubMed  Google Scholar 

  39. Stewart W, Corey R, Herzog A et al (2001) Prevalence of overactive bladder in women: results from the NOBLE program. Int Urogynecol J 12:S66

    Google Scholar 

  40. Rosa GM, Bauckneht M, Scala C et al (2013) Cardiovascular effects of antimuscarinic agents in overactive bladder. Expert Opin Drug Saf 12:815–827

    Article  CAS  PubMed  Google Scholar 

  41. Abrams P, Andersson KE (2007) Muscarinic receptor antagonists for overactive bladder. BJU Int 100:987–1006

    Article  CAS  PubMed  Google Scholar 

  42. Chancellor M, Boone T (2012) Anticholinergics for overactive bladder therapy: central nervous system effects. CNS Neurosci Ther 18:167–174

    Article  CAS  PubMed  Google Scholar 

  43. Ishizaka N, Noda M, Yokoyama S et al (1998) Muscarinic acetylcholine receptor subtypes in the human iris. Brain Res 787:344–347

    Article  CAS  PubMed  Google Scholar 

  44. Andersson KE, Campeau L, Olshansky B (2011) Cardiac effects of muscarinic receptor antagonists used for voiding dysfunction. Br J Clin Pharmacol 72:186–196

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Griebling TL, Campbell NL, Mangel J et al (2020) Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4 randomized, placebo-controlled study (PILLAR). BMC Geriatr 20:1–10

    Article  Google Scholar 

  46. By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society (2019) Updated AGS beers criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019(67):674–694

    Google Scholar 

  47. O’Mahony D, O’Sullivan D, Byrne S et al (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218

    Article  PubMed  PubMed Central  Google Scholar 

  48. Bahat G, Ilhan B, Erdogan T et al (2020) Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 11:491–498

    Article  PubMed  PubMed Central  Google Scholar 

  49. Bahat G, Ilhan B, Erdogan T et al (2021) International validation of the Turkish inappropriate medication use in the elderly (time) criteria set: a Delphi panel study. Drugs Aging 38:513–521

    Article  PubMed  PubMed Central  Google Scholar 

  50. Moga DC, Carnahan RM, Lund BC et al (2013) Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers. J Am Med Dir Assoc 14:749–760

    Article  PubMed  Google Scholar 

  51. Lackner TE, Wyman JF, McCarthy TC et al (2008) Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc 56:862–870

    Article  PubMed  Google Scholar 

  52. Green AR, Segal J, Boyd CM et al (2020) Patterns of potentially inappropriate bladder antimuscarinic use in people with dementia: a retrospective cohort study. Drugs-Real World Outcomes 7:151–159

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kao LT, Huang CY, Lin HC, Chu CM (2018) No increased risk of fracture in patients receiving antimuscarinics for overactive bladder syndrome: a retrospective cohort study. J Clin Pharmacol 58:727–732

    Article  CAS  PubMed  Google Scholar 

  54. Kachru N, Holmes HM, Johnson ML et al (2021) Comparative risk of adverse outcomes associated with nonselective and selective antimuscarinic medications in older adults with dementia and overactive bladder. Int J Geriatr Psychiatry 36:684–696

    Article  PubMed  Google Scholar 

  55. Yang N, Wu Q, Xu F, Zhang X (2021) Comparisons of the therapeutic safety of seven oral antimuscarinic drugs in patients with overactive bladder: a network meta-analysis. J Int Med Res 49:03000605211042994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Mostafaei H, Salehi-Pourmehr H, Jilch S et al (2021) Choosing the most efficacious and safe oral treatment for idiopathic overactive bladder: a systematic review and network meta-analysis. Eur Urol Focus

  57. Vouri SM, Kebodeaux CD, Stranges PM, Teshome BF (2017) Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr 69:77–96

    Article  CAS  PubMed  Google Scholar 

  58. Andersson KE, Sarawate C, Kahler KH et al (2010) Cardiovascular morbidity, heart rates and use of antimuscarinics in patients with overactive bladder. BJU Int 106:268–274

    Article  PubMed  Google Scholar 

  59. Harvey RD (2012) Muscarinic receptor agonists and antagonists: effects on cardiovascular function. Muscarin Recep 2:299–316

    Article  Google Scholar 

  60. Leone Roberti Maggiore U, Salvatore S, Alessandri F et al (2012) Pharmacokinetics and toxicity of antimuscarinic drugs for overactive bladder treatment in females. Exp Opin Drug Metab Toxicol 8:1387–1408

    Article  Google Scholar 

  61. Serra DB, Affrime MB, Bedigian MP et al (2005) QT and QTc interval with standard and supratherapeutic doses of darifenacin, a muscarinic M3 selective receptor antagonist for the treatment of overactive bladder. J Clin Pharmacol 45:1038–1047

    Article  CAS  PubMed  Google Scholar 

  62. Nitti VW, Dmochowski R, Sand PK et al (2007) Efficacy, safety and tolerability of fesoterodine for overactive bladder syndrome. J Urol 178:2488–2494

    Article  CAS  PubMed  Google Scholar 

  63. Malhotra B, Wood N, Sachse R, Gandelman K (2010) Thorough QT study of the effect of fesoterodine on cardiac repolarization. Int J Clin Pharmacol Ther 48:309–318

    Article  CAS  PubMed  Google Scholar 

  64. Guay DR (2005) Trospium chloride: an update on a quaternary anticholinergic for treatment of urge urinary incontinence. Ther Clin Risk Manag 1:157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Hussain R, Hartigan-Go K, Thomas S, Ford G (1996) Effect of oxybutynin on the QTc interval in elderly patients with urinary incontinence. Br J Clin Pharmacol 41:73–75

    Article  CAS  PubMed  Google Scholar 

  66. Jones SE, Kasamaki Y, Shuba LM et al (2000) Analysis of the electrophysiologic effects of short-term oxybutynin on guinea pig and rabbit ventricular cells. J Cardiovasc Pharmacol 35:334–340

    Article  CAS  PubMed  Google Scholar 

  67. Asajima H, Sekiguchi Y, Matsushima S et al (2008) QT prolongation and torsade de pointes associated with solifenacin in an 81-year-old woman. Br J Clin Pharmacol 66:896

    Article  PubMed  PubMed Central  Google Scholar 

  68. Hoffstetter S, Che LF (2009) Solifenacin succinate for the treatment of overactive bladder. Expert Opin Drug Metab Toxicol 5:345–350

    Article  CAS  PubMed  Google Scholar 

  69. Kang J, Chen X-L, Wang H et al (2004) Cardiac ion channel effects of tolterodine. J Pharmacol Exp Ther 308:935–940

    Article  CAS  PubMed  Google Scholar 

  70. Malhotra B, Glue P, Sweeney K et al (2007) Thorough QT study with recommended and supratherapeutic doses of tolterodine. Clin Pharmacol Ther 81:377–385

    Article  CAS  PubMed  Google Scholar 

  71. Garfinkel D, Ilhan B, Bahat G (2015) Routine deprescribing of chronic medications to combat polypharmacy. Therap Adv Drug Safety 6:212–233

    Article  CAS  Google Scholar 

  72. Carnahan RM, Lund BC, Perry PJ, Chrischilles EA (2004) The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice? J Am Geriatr Soc 52:2082–2087

    Article  PubMed  Google Scholar 

  73. Sink KM, Thomas J III, Xu H et al (2008) Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes. J Am Geriatr Soc 56:847–853

    Article  PubMed  PubMed Central  Google Scholar 

  74. Tannenbaum C, Johnell K (2014) Managing therapeutic competition in patients with heart failure, lower urinary tract symptoms and incontinence. Drugs Aging 31(2):93–101. https://doi.org/10.1007/s40266-013-0145-1

    Article  CAS  PubMed  Google Scholar 

  75. Srikrishna S, Robinson D, Cardozo L (2014) Important drug–drug interactions for treatments that target overactive bladder syndrome. Int Urogynecol J 25:715–720

    Article  PubMed  Google Scholar 

  76. Athanasopoulos A, Giannitsas K (2011) An overview of the clinical use of antimuscarinics in the treatment of overactive bladder. Adv Urol 20:11

    Google Scholar 

  77. Trospium: Drug information, Lexicomp Online. In. 2022

  78. Seppala LJ, Petrovic M, Ryg J et al (2021) STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk): a Delphi study by the EuGMS task and finish group on fall-risk-increasing drugs. Age Ageing 50:1189–1199

    Article  PubMed  Google Scholar 

  79. Pazan F, Weiss C, Wehling M (2022) The FORTA (Fit fOR The Aged) list 2021: fourth version of a validated clinical aid for improved pharmacotherapy in older adults. Drugs Aging 39(3):245–247. https://doi.org/10.1007/s40266-022-00922-5

    Article  PubMed  PubMed Central  Google Scholar 

  80. Oelke M, Becher K, Castro-Diaz D, Chartier-Kastler E, Kirby M, Wagg A, Wehling M (2015) Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014). Age Ageing 44(5):745–755. https://doi.org/10.1093/ageing/afv077

    Article  PubMed  PubMed Central  Google Scholar 

  81. Ha M, Furman A, Al Rihani SB et al (2022) Pharmacist‐driven interventions to de‐escalate urinary antimuscarinics in the Programs of All‐Inclusive Care for the Elderly. J Am Geriatr Soc

  82. Deprescribing guide for anticholinergic drugs for urinary incontinence. The NSW Therapeutic Advisory Group. In. 2022.

  83. Gravas SC, Gacci JN, Gratzke M, Herrmann C, Mamoulakis TRW, Rieken C, Speakman M, Tikkinen MJ, KAO (2022) EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). European Association of Urology 2022. In 2022 Edition

  84. McVary KT (2022) Medical treatment of benign prostatic hyperplasia. In: O'Leary MPGJ (ed) Uptodate. pp 1–2

  85. Djavan B, Chapple C, Milani S, Marberger M (2004) State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 64:1081–1088

    Article  PubMed  Google Scholar 

  86. Barendrecht MM, Abrams P, Schumacher H et al (2008) Do α1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27:226–230

    Article  CAS  PubMed  Google Scholar 

  87. McConnell JD, Roehrborn CG, Bautista OM et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398

    Article  CAS  PubMed  Google Scholar 

  88. Boyle P, Robertson C, Manski R et al (2001) Meta-analysis of randomized trials of terazosin in the treatment of benign prostatic hyperplasia. Urology 58:717–722

    Article  CAS  PubMed  Google Scholar 

  89. Roehrborn C (2006) Three months’ treatment with the α1-blocker alfuzosin does not affect total or transition zone volume of the prostate. Prostate Cancer Prostatic Dis 9:121–125

    Article  CAS  PubMed  Google Scholar 

  90. Roehrborn CG, Siami P, Barkin J et al (2008) The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 179:616–621

    Article  CAS  PubMed  Google Scholar 

  91. Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57:123–131

    Article  CAS  PubMed  Google Scholar 

  92. (2022) Duloxetin, terazosin, alfuzosin, silodosin: drug information, lexicomb. Online

  93. Vaughan CP, Brown CJ, Goode PS et al (2010) The association of nocturia with incident falls in an elderly community-dwelling cohort. Int J Clin Pract 64:577–583

    Article  CAS  PubMed  Google Scholar 

  94. Temml C, Ponholzer A, Gutjahr G et al (2009) Nocturia is an age-independent risk factor for hip-fractures in men. Neurourol Urodyn 28:949–952

    Article  PubMed  Google Scholar 

  95. Welk B, McArthur E, Fraser L-A et al (2015) The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study. BMJ 351:2

    Google Scholar 

  96. Lee M (2000) Tamsulosin for the treatment of benign prostatic hypertrophy. Ann Pharmacother 34:188–199

    Article  CAS  PubMed  Google Scholar 

  97. Roehrborn CG, Van Kerrebroeck P, Nordling J (2003) Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int 92:257–261

    Article  CAS  PubMed  Google Scholar 

  98. Marks LS, Gittelman MC, Hill LA et al (2009) Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol 181:2634–2640

    Article  CAS  PubMed  Google Scholar 

  99. Nickel J, Sander S, Moon T (2008) A meta-analysis of the vascular-related safety profile and efficacy of α-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62:1547–1559

    Article  CAS  PubMed  Google Scholar 

  100. Barendrecht MM, Koopmans RP, De La Rosette JJ, Michel MC (2005) Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system. BJU Int 95:19–28

    Article  CAS  PubMed  Google Scholar 

  101. Nieminen T, Tammela TL, Koobi T, Kahonen M (2006) The effects of tamsulosin and sildenafil in separate and combined regimens on detailed hemodynamics in patients with benign prostatic enlargement. J Urol 176:2551–2556

    Article  CAS  PubMed  Google Scholar 

  102. Chapple CR, Montorsi F, Tammela TL et al (2011) Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol 59:342–352

    Article  CAS  PubMed  Google Scholar 

  103. Novara G, Chapple CR, Montorsi F (2014) A pooled analysis of individual patient data from registrational trials of silodosin in the treatment of non-neurogenic male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). BJU Int 114:427–433

    CAS  PubMed  Google Scholar 

  104. Yu HJ, Lin ATL, Yang SSD et al (2011) Non-inferiority of silodosin to tamsulosin in treating patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). BJU Int 108:1843–1848

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Internal Medicine, and Geriatrics Clinic, Liv Hospital Vadi Istanbul, Istanbul, Turkey

    Birkan İlhan

  2. Geriatrics Clinic, Tekirdağ Dr. Ismail Fehmi Cumalıoglu City Hospital, Tekirdağ, Turkey

    Tuğba Erdoğan

  3. Department of Geriatric Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague and Faculty of Health and Social Sciences, University of South Bohemia, České Budejovice, Czechia

    Eva Topinková

  4. Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey

    Gülistan Bahat

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İlhan, B., Erdoğan, T., Topinková, E. et al. Management of use of urinary antimuscarinics and alpha blockers for benign prostatic hyperplasia in older adults at risk of falls: a clinical review. Eur Geriatr Med 14, 733–746 (2023). https://doi.org/10.1007/s41999-023-00798-7

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