Overactive Bladder Treatment with Antimuscarinic Drugs

Clinical Efficacy and Guideline Recommendations

• The AUA/SUFU guidelines recommend both oxybutynin and tolterodine as equivalent second-line therapies after behavioral interventions fail, with no hierarchy implied among these antimuscarinic options in terms of efficacy 1
• The European Association of Urology similarly recommends both agents as acceptable oral antimuscarinic options 2
• Both medications show equivalent efficacy for treating overactive bladder symptoms 1

Tolerability and Safety

• The AUA/SUFU guidelines recommend transdermal oxybutynin preparations if dry mouth is a concern with oral antimuscarinics 1
• Check post-void residual volume in patients at risk for urinary retention, such as men with lower urinary tract symptoms or suspected bladder outlet obstruction 3, 4
• Obtain clearance from specialists for patients with gastric emptying problems or urinary retention risk 1

Contraindications and Side Effects

• Both medications are contraindicated in patients with narrow-angle glaucoma, impaired gastric emptying, and history of urinary retention 1, 2
• Common antimuscarinic adverse effects include dry mouth, constipation, dry eyes and blurred vision, dyspepsia, urinary tract infection, urinary retention, and impaired cognitive function 1, 2