Overactive bladder: improving the efficacy of anticholinergics by dose escalation

Overactive bladder (OAB) affects millions of people in the United States and significantly impacts their quality of life. New antimuscarinic anticholinergic medications have improved the treatment of OAB, offering patients efficacy equal to that of immediate-release oxybutynin with fewer side effects and an improved dosing schedule. The commonly reported range of reduction of urge incontinence episodes is between 46% and 92%. Although patients are improving, continence rates are lower and many responders continue to leak significantly. The literature supports that the efficacy of anticholinergics is enhanced by dose escalation, but using higher dosages has not become routine in clinical practice. Although dose escalation can be implemented with all of the anticholinergics, it is done most easily and approved by the US Food and Drug Administration with extended-release oxybutynin. This paper critically evaluates the pros and cons of dose escalation in the hope to improve efficacy in patients with OAB.