Antimuscarinic Pharmacotherapy for Overactive Bladder



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.


Overactive bladder Antimuscarinics Urgency Incontinence Anticholinergics Oxybutynin Lower urinary tract symptoms 



5-Hydroxymethyl tolterodine


Antimuscarinic clinical effectiveness trial




Clean intermittent catheterization


Central nervous system






Detrusor overactivity


Extended release


Health-related quality of life


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


Immediate release


Lower urinary tract


Muscarinic receptor


Overactive bladder


Overactive bladder: performance of extended-release agents trial




Oxybutynin transdermal delivery system




Post-void residuals


Corrected QT interval


Randomized controlled trial


Spinal cord injury


Solifenacin and tolterodine as an active comparator in a randomized trial


Transdermal delivery system




Urgency urinary incontinence


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of PennsylvaniaPhiladelphiaUSA

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