CENTRAL NERVOUS SYSTEM ADVERSE DRUG EVENTS OF ANTIMUSCARINIC MEDICATION
Authors:
E. Topinková
Authors‘ workplace:
Geriatrická klinika 1. LF UK a VFN v Praze
Published in:
Urol List 2012; 10(1): 69-74
Overview
Overactive bladder (OAB) is characterized by episodes of urgency, micturition frequency, nocturia and, in majority of patients, by urge incontinence. OAB is a chronic disease, which impairs quality of life. Its prevalence increases with advancing age and affects 11–16% of adult population and up to 20–30% of elderly persons above 70 years. The pharmacological treatments of choice are urinary spasmolytics (antimuscarinics) with antagonist effect on muscarinic (M) receptors in the bladder. As the tissue selectivity of antimuscarinics for bladder M receptors is only relative there is increasing awareness of potential adverse effects of antimuscarinics on the brain M receptors, which play significant role in cognitive and memory processes. The article reviews current knowledge on central nervous system anticholinergic adverse drug events (ADE) of antimuscarinics, providing information of pharmacochemical properties of individual drugs that determine brain penetration and their possible CNS ADE. The safe antimuscarinic seems to be trospium chloride which does not cross blood brain barrier and the central ADEs such as confusion, dizziness, memory impairment and impaired sleep architecture are clinically non significant. Metaanalyses of clinical trials confirm generally low frequency of CNS ADE. However, they stress that standard protocols of clinical trials do not consistently report occurrence of CNS ADE neither do they assess spectrum of cognitive performance. It is recommended to use standard neuropsychological battery in future clinical trials, which will enable to detect cognitive ADE of antimuscarinics during short- and long-term treatment. In clinical practice before starting treatment with antimuscarinics it is recommended to assess cognitive functions and identify patients with increased risk of CNS ADEs (patients with concomitant use of other anticholinergic drugs and patients with pre-existing structural brain pathology) for whom antimuscarinics with lowest potential of CNS ADEs are an option (trospium chloride, darifenacin, fesoterodin).
Key words:
overactive bladder, antimuscarinic drugs, adverse drug events, central anticholinergic effect, cognitive performance
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Paediatric urologist UrologyArticle was published in
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