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Overactive Bladder Drugs and Constipation: A Meta-Analysis of Randomized, Placebo-Controlled Trials

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Abstract

Background

Anticholinergic drugs are commonly prescribed for symptomatic treatment of overactive bladder (OAB). While recent meta-analyses have characterized the prevalence of dry mouth among patients utilizing OAB medications, prevalence of constipation has not been systematically reviewed.

Aims

To provide an effect measure for constipation associated with anticholinergic OAB drugs versus placebo.

Methods

A meta-analysis of trials with darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium was conducted. All randomized, placebo-controlled studies of anticholinergic OAB drugs published in English language and identified in Medline and Cochrane databases were considered for inclusion in this meta-analysis. Those meeting predetermined design characteristics and having sufficient duration (≥2 weeks) were included. Constipation-related data from all included studies were abstracted.

Results

One hundred two English-language, randomized, placebo-controlled trials were originally identified. Thirty-seven studies were ultimately included in the analysis, involving 19,434 total subjects (12,368 treatment + 7,066 placebo patients). The odds ratios for constipation compared with placebo were as follows: overall [odds ratio (OR) 2.18, 95% confidence interval (CI) = 1.82–2.60], tolterodine (OR 1.36, 95% CI = 1.01–1.85), darifenacin (OR 1.93, 95% CI = 1.40–2.66), fesoterodine (OR 2.07, 95% CI = 1.28–3.35), oxybutynin (OR 2.34, 95% CI = 1.31–4.16), trospium (OR 2.93, 95% CI = 2.00–4.28), and solifenacin (OR 3.02, 95% CI = 2.37–3.84).

Conclusions

Our results demonstrate that patients prescribed anticholinergic OAB drugs are significantly more likely to experience constipation. Differences in muscarinic receptor affinities among individual agents may possibly account for the modest variation in constipation rates observed; however, such a determination warrants additional research.

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Acknowledgments

This work was performed without financial support. The authors of this paper have no financial interests to declare.

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Authors and Affiliations

  1. Research Institute for Health Outcomes, Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue, Albany, NY, 12208-3425, USA

    Patrick D. Meek

  2. School of Pharmacy at Dallas, Texas Tech University, 5920 Forest Park Lane, Suite 400, Dallas, TX, 75235, USA

    Samuel D. Evang

  3. College of Pharmacy, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 800, Memphis, TN, 38163, USA

    Mina Tadrous

  4. Pharmacy Services, IPRO, 20 Corporate Woods Boulevard, Albany, NY, USA

    Dianne Roux-Lirange & Darren M. Triller

  5. Albany Gastroenterology Consultants, 1375 Washington Avenue, Suite 101, Albany, NY, 12206, USA

    Bora Gumustop

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  1. Patrick D. Meek
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Correspondence to Patrick D. Meek.

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10620_2010_1313_MOESM2_ESM.eps

Fig. S3. Meta-analysis of studies of anticholinergic drugs versus placebo for overactive bladder in the analysis of constipation events (subgroup analyses by treatment duration and trial quality). (EPS 1,043 kb)

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Meek, P.D., Evang, S.D., Tadrous, M. et al. Overactive Bladder Drugs and Constipation: A Meta-Analysis of Randomized, Placebo-Controlled Trials. Dig Dis Sci 56, 7–18 (2011). https://doi.org/10.1007/s10620-010-1313-3

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