Overactive bladder medication — do we need to revisit trospium chloride for our elderly patients?

Excerpt

It is accepted that the prevalence of OAB increases with age. Currently the mainstay of overactive bladder (OAB) therapy are antimuscarinic/anti-cholinergic or beta 3 adrenergic medications. We are all familiar with the antimuscarinic medications currently available, including oxybutynin, tolterodine, trospium, solifenacin, darifenacin, and fesoterodine. Antimuscarinic medications work by blocking muscarinic receptors in the detrusor muscle, thus reducing the ability of the detrusor muscle to forcefully contract. Muscarinic receptors are labelled M1–M5, with M2 and M3 receptors being found prominently in the bladder. While these drugs block M2 and M3 receptors in the bladder, they can also block other muscarinic receptors, leading to the well-known side-effects of dry eyes, dry mouth, and constipation. The concern has arisen that they can also block M1 and M2 receptors in the brain. These receptors are responsible for higher cognitive function, and disruption of these receptors can result in side-effects relating to learning, memory, and confusion. If the medications can cross the blood–brain barrier into the central nervous system, cognitive side–effects can occur. …