Rationale for the Use of Anticholinergic Agents in Overactive Bladder with Regard to Central Nervous System and Cardiovascular System Side Effects

Overview

Journal Korean J Urol

Specialty Urology

Date 2013 Dec 24

PMID 24363860

Citations 13

Authors

Bulent Cetinel

Bulent Onal

Affiliations

Soon will be listed here.

Abstract

Purpose: Central nervous system (CNS) and cardiovascular system (CVS) side effects of anticholinergic agents used to treat overactive bladder (OAB) are underreported. Hence, this review aimed to focus on the mechanisms of CNS and CVS side effects of anticholinergic drugs used in OAB treatment, which may help urologists in planning the rationale for OAB treatment.

Materials And Methods: PubMed/MEDLINE was searched for the key words "OAB," "anticholinergics," "muscarinic receptor selectivity," "blood-brain barrier," "CNS," and "CVS side effects." Additional relevant literature was determined by examining the reference lists of articles identified through the search.

Results: CNS and CVS side effects, pharmacodynamic and pharmacokinetic properties, the metabolism of these drugs, and the clinical implications for their use in OAB are presented and discussed in this review.

Conclusions: Trospium, 5-hydroxymethyl tolterodine, darifenacin, and solifenacin seem to have favorable pharmacodynamic and pharmacokinetic properties with regard to CNS side effects, whereas the pharmacodynamic features of darifenacin, solifenacin, and oxybutynin appear to have an advantage over the other anticholinergic agents (tolterodine, fesoterodine, propiverine, and trospium) with regard to CVS side effects. To determine the real-life situation, head-to-head studies focusing especially on CNS and CVS side effects of OAB anticholinergic agents are urgently needed.

Citing Articles

Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study.

Iyen B, Coupland C, Bell B, Ashcroft D, Orrell M, Bishara D BMJ Med. 2024; 3(1):e000799.

PMID: 39574420 PMC: 11580265. DOI: 10.1136/bmjmed-2023-000799.

Safety and Tolerability of Fesoterodine in Older Adult Patients with Overactive Bladder.

Heesakkers J, Te Dorsthorst M, Wagg A Can Geriatr J. 2022; 25(1):72-78.

PMID: 35310472 PMC: 8887709. DOI: 10.5770/cgj.25.530.

Anticholinergic drugs and risk of dementia: Time for action?.

Bell B, Avery A, Bishara D, Coupland C, Ashcroft D, Orrell M Pharmacol Res Perspect. 2021; 9(3):e00793.

PMID: 34087056 PMC: 8177062. DOI: 10.1002/prp2.793.

Antimuscarinic Cascade Across Individual Cholinesterase Inhibitors in Older Adults with Dementia.

Masurkar P, Chatterjee S, Sherer J, Aparasu R Drugs Aging. 2021; 38(7):593-602.

PMID: 34027602 DOI: 10.1007/s40266-021-00863-5.

Alzheimer's disease and related dementias risk: Comparing users of non-selective and M3-selective bladder antimuscarinic drugs.

Barthold D, Marcum Z, Gray S, Zissimopoulos J Pharmacoepidemiol Drug Saf. 2020; 29(12):1650-1658.

PMID: 32852147 PMC: 7825274. DOI: 10.1002/pds.5098.

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