Begin a trial of an antimuscarinic
if initial nonpharmacologic treatment of urge incontinence or overactive bladder is ineffective.
assessment of antimuscarinics
for treating overactive bladder: A network
Therefore, the efficacy and safety of the long-term use of antimuscarinics
alone or in combination with an a-blocker in men with an enlarged prostate is still unclear.
If a first antimuscarinic
medication doesn't work or causes unacceptable side effects, modify the dose or offer a different antimuscarinic
or beta3-adrenoceptor agonist, the guideline states.
AltheRx Pharmaceuticals, a United States-based clinical development company, has received a notice of allowance for the use of solabegron in combination with antimuscarinics
at both therapeutic and sub-therapeutic doses, for the treatment of overactive bladder, from the US Patent and Trademark Office.
If one antimuscarinic
agent fails to control symptoms or causes intolerable side effects, a second antimuscarinic
agent might provide better symptom control and/or a more acceptable side-effect profile versus abandoning the class of medicines altogether.
Behavioral therapy is probably at least as efficacious as antimuscarinics
, but it does not expose patients to the risks of drug therapy.
include darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium, which all have similar efficacy, In general, patients with more severe symptoms have a greater degree of response to medications, regardless of which medication is chosen.
However, the lack of selectivity of antimuscarinics
to the muscarinergic receptors of the bladder muscle and urothelial cells leads to systemic anticholinergic side effects, such as dry mouth, tachycardia, cognitive problems, constipation and accommodation paralysis (i.
Often, we combine biofeedback with antimuscarinics
and behavioral modification," Dr.
Although very rare and preventable in most cases, some eye drops such as antimuscarinics
(atropine and cyclopentolate) (24-26) and cholinergic agents (pilocarpine) (27-28) are reported to induce psychotic reactions after excessive or even normal quantities.
Blockade of apomorphine-induced aggression by morphine or neuroleptics: differential alteration by antimuscarinics
or Antispasmodics Calcium Channel Blockers Add Verapamil to Digoxin 0.
and beta-3 agonists have similar efficacy; however, their side effect profiles and costs usually dictate medication choice (Wagg et al.
Pharmacologic treatment typically consists of antimuscarinics
(eg, oxybutynin, tolterodine, solifenacin) and tricyclic antidepressants (eg, imipramine).