Antimuscarinics: properties and use in overactive bladder

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KEY POINTSantimuscarinic agents are a diverse group with varying requirements for dose adjustment in patients with impaired eliminationantimuscarinic agents lack specificity for muscarinic receptors on the bladder and share a common pattern of dose-dependent adverse reactions; the commonest adverse reaction is dry mouthinteractions with other inhibitors or inducers of hepatic microsomal enzymes may be clinically significant and pharmacodynamic interactions occur with other drugs with antimuscarinic activitymost undergo extensive hepatic metabolism and have active metabolitesantimuscarinics are contraindicated in patients whose condition may be exacerbated by antimuscarinic activitymodified-release formulations may reduce the risk of dose-dependent adverse effectsnewer preparations do not necessarily carry a lower discontinuation rate compared with older agentsSteve Chaplin and Mr Frank Lee provide an overview of the properties of antimuscarinics and their current recommended place in the treatment of overactive bladder.

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