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Current Geriatrics Reports

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01-03-2023 | Oxybutynin | Review

Anticholinergic Use for OAB in the Older Woman: An Update

Authors: Berkley Davis, Katherina Chen, Olivia Markert, Jacqueline Zillioux

Published in: Current Geriatrics Reports | Issue 2/2023

Abstract

Purpose

This expert narrative review discusses the role of anticholinergic therapy for overactive bladder in older women with a focus on recent evidence regarding serious safety concerns.

Recent Findings

Anticholinergics are the most commonly utilized treatment for overactive bladder; however, recent large observational studies suggest a significant association between anticholinergic use for overactive bladder and increased risk of dementia. Additional studies have also raised concerns for increased risk of falls, fractures, and all-cause mortality. Differences may exist among various specific anticholinergic drugs, with highest risk associated with oxybutynin. Similar risks have not been found with the other class of overactive bladder pharmacotherapy, beta-3 adrenergic agonists.

Summary

Older women are at increased risk for overactive bladder and are particularly vulnerable to the adverse side effects of anticholinergic medication. Although further research is needed, given mounting concerns for serious and irreversible potential adverse effects associated with anticholinergic use for overactive bladder, this class should be used with caution in older women and alternative effective therapies should be considered.

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Zillioux J, Welk B, Suskind AM, Gormley EA, Goldman HB. SUFU white paper on overactive bladder anticholinergic medications and dementia risk. Neurourol Urodyn 2022;41:1928–33. https://doi.org/10.1002/nau.25037. This white paper provides practical clinical guidance on the use of OAB anticholinergics in the context of current evidence surrounding their cognitive risks. The authors recommend preferential use of a beta-3 agonist over anticholinergics for OAB pharmacotherapy and avoiding oxybutynin immediate release when an OAB anticholinergic is indicated.

Title: Anticholinergic Use for OAB in the Older Woman: An Update
Authors: Berkley Davis
Katherina Chen
Olivia Markert
Jacqueline Zillioux
Publication date: 01-03-2023
Publisher: Springer US
Keywords: Oxybutynin
Overactive Bladder
Dementia
Trospium
Fesoterodine
Dementia
Tolterodine
Solifenacin
Darifenacin
Published in: Current Geriatrics Reports / Issue 2/2023
Electronic ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-023-00380-w

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