Pharmacotherapy for overactive bladder: an evidence-based approach to selecting an antimuscarinic agent

Multiple drugs are now available for the treatment of overactive bladder. Currently, the pharmacological approach is to deal with the problem at the neuromuscular junction by attempting to stop the activity of the neurotransmitter with antimuscarinic medications. This article reviews the positive and negative aspects of the agents that are currently available for use in the US. In randomised clinical trials, extended-release formulations of these agents appear as effective as the immediate-release formulations, but are associated with fewer adverse effects. Attempts to use entities that are muscarinic M(3) selective antimuscarinic agents have not significantly improved the efficacy, but have reduced the major adverse effect of excessively dry mouth. Dose escalation or titration is addressed to enhance efficacy further. None of these drugs appear to cause significant cardiac or CNS adverse events. This supports the continued use of these agents for overactive bladder symptomatology, as they appear to be effective in reducing symptoms and remain generally well tolerated.