Cognitive and mood side effects of lower urinary tract medication

ABSTRACT

Introduction: Muscarinic receptor antagonists, 5α-reductase inhibitors and α₁-adrenoceptor antagonists are frequently used drug classes for the treatment of lower urinary tract symptoms including those of overactive bladder syndrome and benign prostatic enlargement/benign prostatic obstruction.

Areas covered: The authors review the evidence for adverse effects of these drug classes on cognitive function, mood and other functions of the central nervous system and discuss such effects against the evidence for mechanistic plausibility.

Expert opinion: Muscarinic antagonists carry a risk for impaired cognition and other brain functions that differs quantitatively between compounds, being highest with oral formulations of oxybutynin. 5□-Reductase inhibitors can cause depressive symptoms even at low doses and starting several months after discontinuation of treatment. The evidence for α₁-adrenoceptor antagonists and specifically tamsulosin to cause dementia is controversial and lacks mechanistic plausibility. We recommend that physicians treating patients with lower urinary tract symptoms carefully monitor mental status prior to prescribing and periodically thereafter.

KEYWORDS:

• 5α-reductase inhibitors
• α₁-adrenoceptor antagonists
• cognitive impairment
• depression
• muscarinic receptor antagonists

Article highlights

• LUTS medications are typically prescribed in an age group vulnerable for disturbances of cognition and mood and carry a risk of provoking or worsening such conditions.

• Evidence is strongest and effect sizes greatest for muscarinic receptor antagonists, but not all members of this class generate a similar risk.

• Strong evidence suggests an increased incidence of newly diagnosed depression upon use of 5α-reductase inhibitors.

• Evidence for an increased risk of dementia associated with use of tamsulosin in one study has not been confirmed in another.

• This box summarizes key points contained in the article.

Declaration of interest

KF Becher reports consulting and/or lecturing for Astellas, Ferring, and Pfizer. S Madersbacher reports consulting and/or lecturing for Astellas, Ferring, and GSK. MC Michel reports consulting and/or lecturing for Apogepha, Astellas, Ferring, and Velicept; he also is a shareholder of Velicept and a past employee of Boehringer Ingelheim (until 2016). AEM does not report a conflict of interest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.