Basic characteristics of the antimuscarinic drugs
Darifenacin 507.5 Low M3 Fesoterodine 527.6 Low Non-selective Oxybutynin 393.9 High Non-selective Propiverine 403.9 (*) Limited data Non-selective Solifenacin 480.5 Moderate Predominantly M3 Tolterodine 475.6 Moderate Non-selective Trospium 427.9 Low Non-selective BBB: Blood-brain barrier, (*) Value expressed in g/moL Table 2.
Treatment-naive patients taking mirabegron demonstrated statistically significantly greater persistence compared with those taking antimuscarinic drugs (Table 3, Fig.
A lower incidence of anticholinergic adverse events with mirabegron seen in clinical trials may explain the improved persistence and adherence rates compared with antimuscarinic drugs. However, the persistence rate of 31.7% with mirabegron at 12 months in this study still means that about two-thirds of patients discontinued treatment, with a similar gradient of decline in persistence over time to that seen with antimuscarinics.
Postoperatively, 1 patient (3.1%) had de novo urgency, but UDS were normal and she was treated with an antimuscarinic drug
. Vaginal erosion was not documented in any of the patients.
The newer antimuscarinic drugs: bladder control with less dry mouth.
Although selection of the second antimuscarinic drug for combination was at the physician's discretion, a drug that had not been used as monotherapy was preferred as the second antimuscarinic drug.
In clinical practice, patients are considered to have refractory UUI if they have failed at least 2 adequate treatments of antimuscarinic drugs. OnabotuliniumtoxinA (BoNT-A) (off-label), neuromodulation and surgical interventions, such as augmentation cystoplasty, are all acceptable options for a small percentage of patients who do not respond to conservative and drug therapies depending on availability of resources.
For UUI or MUI, antimuscarinic drugs can be prescribed with varying success rates (level of evidence 2, grade B).[sup.30] When starting therapy, important factors, including polypharmacy, pharmacokinetics, adverse drug reactions, drug-drug interactions and drug-disease interactions, must be considered.[sup.14,15] Moreover, dose titration regimen and evaluation of the balance between clinical benefits and side effects should be considered.
Antimuscarinic drugs are first-line treatment for the overactive bladder syndrome (OAB).
Research has suggested that antimuscarinic drugs exert their therapeutic benefit through effects on afferent activity during the filling phase and that there is no proof that, at approved doses, they reduce the ability to empty the bladder.[sup.14] There is a theoretical potential of these agents to have an effect on voiding contraction, but the concentration of antimuscarinic required to achieve this effect would be limited by the potential for side effects.
Table 1.: Advantages and disadvantages of antimuscarinic drugs for overactive bladder [Table omitted]
The evidence for adding estrogen in combination with an antimuscarinic drug is equivocal.