Muscarinic receptor antagonists for overactive bladder treatment: does one fit all?

Abstract

To review evidence and regulatory dosing recommendations for muscarinic receptor antagonists used in the treatment of overactive bladder symptom complex (darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, trospium) in special patient populations. Growing evidence demonstrates effects of renal impairment, hepatic impairment, genetics and/or comedications on the pharmacokinetics of muscarinic antagonists. They may cause greater exposure in the respective population, which may translate into greater risks for side effects. These possible risks lead to drug-specific regulatory dosing recommendations or even contraindications in certain patient populations. Physicians should be aware of pharmacokinetic alterations in special patient populations and possible associated risks. The evidence-based choice of a muscarinic antagonist in such patients should be guided by its specific pharmacokinetic profile.