Maximizing anticholinergic therapy for overactive bladder: has the ceiling been reached?
Author(s): MacDiarmid SA Affiliation(s): Clinical Faculty, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. smacdiarmid@tucpa.com Publication date & source: 2007-06, BJU Int., 99 Suppl 3:8-12. Publication type: Review Urinary incontinence affects an estimated 20-33% of adults the USA and 55% of the country’s elderly [1], having a more substantial impact on the physical and mental dimension of quality of life than other common chronic diseases. Muscarinic receptor antagonists, including oxybutynin, tolterodine, trospium chloride, darifenacin, and solifenacin, are front-line therapies for overactive bladder (OAB), with an efficacy of 65-75% in reducing major symptoms. Strategies to increase the therapeutic index have included behavioural therapy, flexible dosing, and dose escalation, as well as newer formulations that reduce anticholinergic side-effects. Among approved OAB agents, the oxybutynin transdermal-delivery system has been associated with
