Anticholinergic drugs versus other medications for overactive bladder syndrome in adults

Abstract

BackgroundOveractive bladder syndrome is defined as "urgency with or without urge incontinence, usually with frequency and nocturia". It is a common condition with significant economic and quality of life implications. While the condition's pathophysiology remains to be fully elucidated, pharmacotherapy is the main treatment option. Despite uncertainty as to drug treatment of choice, anticholinergics are increasingly being used in primary and secondary care settings. This review compares anticholinergic drugs with other types or classes of drugs for treating overactive bladder syndromes. ObjectivesTo compare anticholinergic drugs with other types or classes of drugs for treating overactive bladder symptoms. Search methodsWe searched the Cochrane Incontinence Group Specialised Trials Register (searched 20 December 2006) and the reference lists of relevant articles. No language or other limits were imposed. Selection criteriaAll randomised and quasi-randomised controlled trials comparing anticholinergic drugs with other drugs for the treatment of overactive bladder symptoms. At least one arm of the study used an anticholinergic drug and at least one other arm used a non-anticholinergic drug. Data collection and analysisTwo reviewers assessed the identified studies for eligibility and methodological quality and independently extracted data from the included studies. Data analysis was performed using RevMan so ware (version 4.2.8). Main resultsTwelve trials were included in the review. There were seven crossover trials and five parallel group studies. For the comparisons between anticholinergic drugs with tricyclic antidepressants, alpha adrenergic agonists, a erent nerve inhibitors, and calcium channel blocker a single trial was identified for each. Nine trials compared flavoxate with anticholinergics. There was no evidence of a di erence in cure rates between anticholinergics and flavoxate. Adverse e ects were more frequent in anticholinergic groups versus flavoxate groups (RR 2.28 95% CI 1.45 to 3.56). There was no strong evidence to favour either anticholinergic drugs or the comparators.

Urinary Incontinence: Revisited

“…There is no evidence to suggest flavoxate should be used in treatment of overactive bladder. 5 6. Others: Includes calcium channel blockers like verapamil, potassium channel openers like pinacidil and cromakalim and Gamma-aminobutyric acid GABA agonists like baclofen.…”

“…There were no demonstrable improvements in urodynamic parameters with verapamil. 5 1. Intravesical botulinum toxin 6 appears to be an effective therapy for refractory OAB symptoms, but as yet little data exist on benefits and safety compared with other interventions, or with placebo.…”

Flavoxate in urogynecology: an old drug revisited

“…Reported adverse events included dry mouth, dizziness, nausea, blurred vision, swelling of lips, diarrhea and constipation. Of 142 patients receiving flavoxate, 22 experienced adverse effects, and of 122 receiving anticholinergic treatment, 50 experienced adverse effects (RR 2.28, 95 % CI 1.45 to 3.56) [36].…”

“…Ten studies comparing flavoxate with anticholinergics were included in a Cochrane review comparing anticholinergic drugs with other types or classes of drugs for treating OAB symptoms [36]. The review showed that there is no difference in cure rates between anticholinergic drugs and flavoxate, but adverse effects are more frequent with anticholinergic drugs than with flavoxate.…”

“…The review showed that there is no difference in cure rates between anticholinergic drugs and flavoxate, but adverse effects are more frequent with anticholinergic drugs than with flavoxate. The authors concluded that there is insufficient evidence to show that flavoxate is better or worse than anticholinergic medications and decided that more and larger RCTs in clinical settings are required to determine the role of flavoxate [36].…”