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Antimuscarinic Pharmacotherapy for Overactive Bladder

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Contemporary Pharmacotherapy of Overactive Bladder

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Abstract

Antimuscarinic agents act by competitively blocking muscarinic receptors in the bladder urothelium and detrusor muscle. These receptors are stimulated by acetylcholine, which is released from cholinergic parasympathetic nerves. Antimuscarinic agents work during the storage phase of the micturition cycle to reduce involuntary bladder contractions and the sensation of urgency. A variety of antimuscarinics are available for use in the treatment of overactive bladder and vary in their pharmacologic properties such as lipophilicity, molecular charge, and molecular size. These property differences result in some theoretical, as well as real, therapeutic advantages and differences in rates of the various adverse effects. Several antimuscarinic agents are in common use including darifenacin, fesoterodine, hyoscyamine, imidafenacin, propantheline bromide, scopolamine, solifenacin, tolterodine, trospium, flavoxate, and oxybutynin. Important clinical data on these drugs is summarized in this chapter.

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Abbreviations

5-HMT:

5-Hydroxymethyl tolterodine

ACET :

Antimuscarinic clinical effectiveness trial

Ach:

Acetylcholine

CIC:

Clean intermittent catheterization

CNS:

Central nervous system

CYP:

Cytochrome

DEO :

N-desethyl-oxybutynin

DO:

Detrusor overactivity

ER :

Extended release

HRQoL:

Health-related quality of life

IMPACT :

Improvement in patients: assessing symptomatic control with tolterodine extended-release study

IR :

Immediate release

LUT:

Lower urinary tract

M:

Muscarinic receptor

OAB:

Overactive bladder

OPERA :

Overactive bladder: performance of extended-release agents trial

OXY :

Oxybutynin

OXY-TDS:

Oxybutynin transdermal delivery system

PDE :

Phosphodiesterase

PVRs :

Post-void residuals

QTc:

Corrected QT interval

RCT:

Randomized controlled trial

SCI :

Spinal cord injury

STAR :

Solifenacin and tolterodine as an active comparator in a randomized trial

TDS:

Transdermal delivery system

TOLT:

Tolterodine

UUI:

Urgency urinary incontinence

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  1. University of Pennsylvania, Philadelphia, PA, USA

    Ariana L. Smith & Alan J. Wein

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    Lindsey Cox

  2. Department of Urology, Medical University of South Carolina, Charleston, SC, USA

    Eric S. Rovner

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Smith, A.L., Wein, A.J. (2019). Antimuscarinic Pharmacotherapy for Overactive Bladder. In: Cox, L., Rovner, E. (eds) Contemporary Pharmacotherapy of Overactive Bladder. Springer, Cham. https://doi.org/10.1007/978-3-319-97265-7_6

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