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Neurourology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Which is TRUE regarding anticholinergic medications?Oxybutynin causes direct smooth muscle relaxation via calcium channel blockade.Tolterodine is M3 receptor specific.M3 receptors are more abundant in the detrusor but M2 receptors are functionally more important.The STAR study compared efficacy, side effect profile and discontinuation rates of solifenacin 5 mg with 10 mg.Fesoterodine is a prodrug that after oral administration is hydrolysed to the same active metabolite as oxybutynin.
Urinary Incontinence
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Dudley Robinson, Linda Cardozo
In order to assess the long-term safety and efficacy of solifenacin a multicentre open-label long-term follow-up study has been reported. This was essentially an extension of two previous double-blind placebo-controlled studies in 1637 patients.121 Overall the efficacy of solifenacin was maintained in the extension study with a sustained improvement in symptoms of urgency, urge incontinence, frequency and nocturia over the 12–month study period. The most commonly reported adverse events were dry mouth (20.5 percent), constipation (9.2 percent) and blurred vision (6.6 percent) and these were the primary reasons for discontinuation in 4.7 percent of patients.
Systemic and intrathecal pharmacologic treatment
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Shachar Aharony, Jacques Corcos
Solifenacin efficacy and tolerability in the treatment of patients with OAB have been evaluated and documented in many multicenter, prospective trials.73–75 Chapple et al.73 conducted the first-ever double-blind, multicenter trial composed of 2-week, single-blind, placebo runin, a 4-week placebo-controlled active treatment phase and 2-week follow-up compared to placebo. Patients were randomized to placebo or solifenacin 2.5, 5, 10, or 20 mg once daily, or TOLT 2 mg twice daily. Solifenacin 5, 10, and 20 mg produced statistically significant improvements (p < .05) in the number of voids/24 hours versus placebo, whereas TOLT did not. Solifenacin was well tolerated. The incidence of dry mouth was 4.9% with placebo, 14.0% with solifenacin 5 mg, 21.3% with solifenacin 10 mg, and 18.6% with TOLT 2 mg twice daily.
The safety and effectiveness of mirabegron in Parkinson’s disease patients with overactive bladder: a randomized controlled trial
Published in Scandinavian Journal of Urology, 2022
Mohamad Moussa, Mohamad Abou Chakra, Baraa Dabboucy, Youssef Fares, Athanasios Dellis, Athanasios Papatsoris
Other randomized controlled trials (RCT) were performed to assess the efficacy of antimuscarinics for the treatment of OAB in patients with PD. An RCT evaluated the efficacy of solifenacin succinate in this setting. Patients were randomized to receive solifenacin succinate 5–10 mg daily or a placebo for 12 weeks followed by an 8-week open-label extension. Results showed that there was an improvement in the number of micturitions per 24 hour period in the solifenacin succinate group compared to placebo at a mean dose of 6 mg/day (p = 0.01) with multiple side effects [20]. Yonguc et al. [21] performed another RCT to test the short-term efficacy and safety of fesoterodine fumarate in PD patients with OAB. Sixty-three patients were randomized to receive fesoterodine 4 mg or placebo for 4 weeks. OAB symptoms were significantly improved in older adults with PD under fesoterodine fumarate treatment, even in the open-label period. The cognitive function was not affected in the treatment group.
Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage
Published in The Aging Male, 2018
Kirill Kosilov, Irina Kuzina, Vladimir Kuznetsov, Yuliya Gainullina, Liliya Kosilova, Alexandra Prokofyeva, Sergey Loparev
It is known that AMs can potentially affect the nervous system, including by causing cognitive impairment, especially in the elderly people. Negative effects of AMs are usually associated with the influence profile on the muscarinic receptor, lipophilicity, the ability to overcome the blood-brain barrier [29]. In a recent study, AM therapy is associated with a decline in cognitive function, namely worsening of semantic memory/language and executive function. However, in this study, despite the release of selective and non-selective AMs, no separate analysis of each AM is performed. Meanwhile, it is known that the effect of different AMs on the nervous system is different. The safety of solifenacin in a standard dosage (5 mg per day) for cognitive function in the elderly people is considered proven. In our study, we increased the dosage by half, assuming that the level of load on the central nervous system of this drug will remain unchanged, which was confirmed by the results obtained.
Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children
Published in Expert Opinion on Pharmacotherapy, 2019
Tiernan Middleton, Pamela Ellsworth
In pediatric patients with NDO from 2 years to <18 years, following oral administration of solifenacin succinate, peak plasma concentrations (Cmax) of solifenacin are reached from 2 to 6 h (median: 3 h) after administration (Tmax) at steady state. The dose-normalized Cmax ranged from 2.49 to 29.26 ng/mL/mg (median: 7.79 ng/mL/mg). Food intake does not significantly affect the exposure of solifenacin. The absolute bioavailability in adults is approximately 90%, with plasma concentrations of solifenacin proportional to the dose administered [52].