Safety Of Anticholinergics Research Articles

Management of JJ stent-related symptoms.

Ureteric JJ stents are inserted in numerous pa- tients as a routine procedure. Nevertheless, the ideal JJ stent that does not cause any lower urinary tract symptoms has not been developed yet. Even special validated ques- tionnaires have been used for the assessment of JJ stent-related symtoms. For the management of such symtoms usually alpha-blockers are admin- istered. Also, studies have examined the efficacy and safety of anticholinergics and calcium channel blo- ckers. In this article we review the literature upon the management of JJ stent-related symptoms.

Traitements pharmacologiques de l’hyperactivité vésicale idiopathique : revue de la littérature

To depict the recent advances in the field of pharmacological treatment of idiopathic overactive bladder (iOAB). A literature search was conducted, using the PubMed/Medline database. Articles were included if published as full papers, after 2008 and before September 2012, and focused on recent pharmacologic treatment options for iOAB management. Publications having the highest level of evidence have been analyzed to summarize the available evidence, prioritizing the treatments available in France. Some meta-analyses have been published between 2008 and 2012, gathering information about 82 level 1 evidence studies about efficacy and safety of anticholinergics. According to the most recent meta-analysis, anticholinergics have proved their efficacy for iOAB management, reducing the number of micturitions per day by up to 1.59, the number of incontinence episodes per day by up to 0.7, the number of urgency episodes by up to 1.7, the number of urgency incontinence episodes by up to 2.25, and the number of nocturnal voids by up to 0.24. Safety profile was good, especially for solifenacin and fesoterodine, supported by strong scientific evidence. However, data were limited to short-term follow-up, with no anticholinergic drug superior to another. Few data were available about observance, risk factors for failure and results in specific populations. Anticholinergics can be used safely for management of lower urinary tract symptoms in men, but their role is still to be determined. Data about innovative drugs were still preliminary. Anticholinergics are a valuable option for management of iOAB, and have a growing role in management of lower urinary tract symptoms in men without bladder outlet obstruction.

Issues on Safety of Long-Acting Muscarinic Antagonist

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled β2 agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.

Combination antimuscarinics and α-blockers for benign prostatic hyperplasia

Millions of men suffer from lower urinary tract symptoms and overactive bladder. The adverse effects on quality of life and the costs associated with the condition have been well described. Although alpha-adrenergic antagonists have long been considered first-line therapy for male lower urinary tract symptoms, many patients have persistent storage symptoms and do not reach their treatment goal. Increasing data and clinical experience support the efficacy and safety of anticholinergics in men, either as monotherapy or in combination with alpha-blockers.

Safety of anticholinergics in patients with benign prostatic hyperplasia

Background: Storage lower urinary tract symptoms (LUTS) or overactive bladder (OAB) often coexist with voiding symptoms in patients with benign prostatic obstruction (BPO). Anticholinergic medications to treat storage LUTS are often withheld in such patients for fear of significantly increasing post-void residual urine volumes or provoking acute urinary retention (AUR). Objective: To assess the clinical validity of concerns regarding urinary safety of anticholinergics in patients with benign prostatic hyperplasia. Methods: Review of indexed literature and congress abstracts. Results/conclusions: Existing urinary and non-urinary safety data on BPO patients administered anticholinergics, either alone or in combination with α-blockers, do not seem to support the above-mentioned concerns. Nevertheless, precise criteria for patient and drug selection to ascertain safe and effective administration are not yet established and need to be investigated in future trials.

Critical Evaluation of the Efficacy and Safety of Anticholinergics in Overactive Bladder

Antimuscarinic agents are the primary pharmacologic treatment of overactive bladder (OAB), and objective clinical data are available in a range of formats including head-to-head studies, systematic reviews and adjusted indirect comparisons. This paper reexamines the various data available on the safety and efficacy of the antimuscarinics. Clinical studies determine whether one treatment is better than another, rather than examining which treatment is best for the individual patient. Favourable treatment outcome may not be attained because of unrealistic expectations of the patient, who may also be dissatisfied with the complications of the treatment. Comparisons between clinical studies on drug therapy for OAB may be complicated by the high placebo response rates. Variations exist in the study populations in terms of symptom severity and tolerance of adverse events, and the diverse methods of assessment employed. Apart from head-to-head studies, meta-analyses can be employed to compare different classes of drugs (lumping method) or individual drugs (splitting method) by pooling of clinical data. The adjusted indirect comparison method has been developed as a method to allow the outcome of two different trials to be compared. Overall, data from clinical trials indicate that the commonly used antimuscarinics have different tolerability and safety profiles but broadly similar efficacy profiles. Consequently, therapy should be tailored to individual patient needs rather than one drug fits all.

Male overactive bladder: The role of urodynamics and anticholinergics

Millions of men suffer from overactive bladder and lower urinary tract symptoms. The adverse effects on quality of life and costs associated with the condition have been well described. In men, the pathophysiology of lower urinary tract symptoms may be from a number of causes including bladder outlet obstruction, detrusor overactivity, or both. Increasing data and clinical experience support the efficacy and safety of anticholinergics in men; the rate of urinary retention has been equal to that of placebo in short-term studies. Urodynamics play a vital role in defining the bladder and/or outlet dysfunction and help direct one's therapy.