Volume 9, Number 4Review ArticlesAnticholinergics and Central Nervous System Effects: Are We Confused?Treatment UpdateDavid R StaskinEdward ZoltanThe central nervous system (CNS) effects of anticholinergic agents have been documented in various patient populations and to varying degrees in case reports, brain-activity surrogates, and computerized cognitive testing. The older patient population with overactive bladder represents a group at increased risk of cognitive impairment and other CNS side effects associated with antimuscarinic agents. The complexity of the effect of anticholinergic agents on CNS function requires an increased level of careful investigation. Studies need to be performed in the at-risk population with multiple, validated tests at clinically prescribed doses in acute and chronic situations. These studies need to take into account the effect of commonly prescribed dosing regimens, with doses selected to represent with equivalent bladder potency. The alterations in the serum levels and parent/metabolite effects contributed by metabolic issues or drug delivery systems require special attention. [Rev Urol. 2007;9(4):191-196]Overactive bladderElderlyAntimuscarinic drugsCNS adverse eventsCognitive impairment
Volume 10, Number 2Review ArticlesConcomitant Medications and Possible Side Effects of Antimuscarinic AgentsTreatment UpdateScott MacDiarmidAntimuscarinic agents are the treatment of choice for overactive bladder syndrome; clinical experience and the literature support their efficacy, tolerability, and safety. The most common side effects experienced include dry mouth and constipation. Many commonly prescribed drugs have anticholinergic effects that could increase the anticholinergic “load” or “burden” in patients with overactive bladder, potentially increasing the frequency and severity of side effects. In addition, the adverse events associated with antimuscarinics may be more pronounced in the elderly, especially those taking multiple medications. Knowledge regarding the potential side effects associated with antimuscarinics is important so that patients can be advised and effectively treated. [Rev Urol. 2008;10(2):92-98]Overactive bladderOxybutyninAntimuscarinic agentsElderlySide effectsTolterodineSolifenacinDarifenacinTrospium chloride
Volume 10, Number 1Review ArticlesMaximizing the Treatment of Overactive Bladder in the ElderlyTreatment UpdateScott MacDiarmidOveractive bladder syndrome affects millions of elderly people in the United States and is equally prevalent in men and women. Its impact on quality of life can be devastating, especially to elderly patients with other medical comorbidities. In order to maximize care, health care providers must be able to make the correct diagnosis and have a working knowledge of available therapies. Data exist supporting the efficacy and safety of nonpharmacologic and pharmacologic therapies. [Rev Urol. 2008;10(1):6-13]IncontinenceOveractive bladder syndromeAntimuscarinic agentsBehavioral therapyElderly