Safety issues associated with using medication to treat overactive bladder

ABSTRACT

Introduction: The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB.

Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer. Studies have shown that the systemic absorption is negligible and does not increase the risk of recurrence.

Expert Opinion: Improvement in assessing anticholinergic load is needed with the development of a universal drug scale. To avoid increasing load, Mirabegron or botulinum toxin can be used instead. There is no consensus of the use of prophylactic antibiotics when injecting botulinum toxin and at what residual to initiate self catheterisation. Despite evidence showing that the use of vaginal oestrogens is safe in those with a history of cancer, it is not fully supported by any health body. Further work is needed in those using aromatase inhibitors.

KEYWORDS:

• Anticholinergic burden
• anticholinergic load
• botox
• botulinum toxin
• breast cancer
• clean intermittent self catheterization (CISC)
• hormone replacement therapy (HRT)
• overactive bladder (OAB)
• urinary tract infection (UTI)
• vaginal oestrogens

Article Highlights

• Anticholinergic load/burden is defined as the cumulative effect of taking one or more drugs, which exert anticholinergic adverse effects.

• The elderly and those with polypharmacy most at risk

• Increasing anticholinergic load, increases risk of cognitive impairment, dementia and possibly death

• Botulinum toxin increases risk of UTI, raised post void residuals and need to CISC, especially amongst the elderly

• Vaginal oestrogens in those with a history of breast cancer can be used in treatment of OAB

• Further work is needed on the use of vaginal oestrogens with those prescribed aromatase inhibitors.

This box summarizes key points contained in the article.

Declaration of interest

L Cardozo has previously received financial support from Allergan, Astellas, BMR, Pfizer, Pierre-Fabre, Syner-Med. G Araklitis has received financial support from Astellas. 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.

Additional information

Funding

This paper has not been funded.