Delivery methods for drugs used in the treatment of overactive bladder

ABSTRACT

Introduction: Overactive bladder affects a significant portion of the population and results in prescribing of numerous medications for its treatment. Traditional drug delivery systems used in therapy are associated with multiple commonly reported side effects. Adherence rates with use of these medications are low. It is likely that low adherence rates with the use of these drugs are due in some part to drug side effects. It is therefore important that alternate methods for drug delivery be explored to reduce side effect profiles and improve patient compliance.

Areas covered: This article addresses the various forms of drug delivery for overactive bladder medications, focusing on those currently in use. Newer systems of drug delivery are also discussed. Through thorough review of research data, randomized trials and meta analyses, drug delivery systems were evaluated.

Expert opinion: Expert opinion favors the use of the transdermal patch and recognizes the necessity for further research and development of other delivery methods. The patch delivery method offers the most effective means of treating symptoms and minimizing drug related adverse side effects leading to treatment discontinuation. Development of OAB medications aimed at alternate receptor targets has the potential to facilitate the creation of new treatment methods to compete with the current standard of care used in OAB treatment.

KEYWORDS:

• Anti-cholinergics
• overactive bladder
• urge incontinence
• urgency

Article highlights.

• Anticholinergic medications used to treat overactive bladder (OAB) symptoms come in both immediate release and extended release formulations with side-effect profiles related to the pharmacology of their metabolism.

• Oral medications are used more often for the treatment of OAB symptoms than other formulations; numerous drugs with differing receptor subtype selectivity are available.

• Beta-3 agonists for OAB are a new form of treatment that are able to avoid traditional side effects due to targeting of alternative receptors in the bladder.

• Transdermal and topical treatments for OAB seek to avoid the first-pass metabolism responsible for many side effects experienced with usage of oral medications.

• Emerging treatments in drug delivery systems aim to avoid adverse effects related to oral metabolites, as well as issues related to topical administration while providing drug delivery closer to the site of action.

This box summarizes key points contained in this article.

Declaration of interest

P Padmanabhan is a consultant to Kimberly-Clark. RR Dmochowski is a consultant to Allergan and Medtronic. 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.