Which medications in the drug class Anticholinergic Agents are used in the treatment of Urinary Incontinence?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Anticholinergic Agents

These agents represent first-line medicinal therapy in women with urge incontinence. These agents are useful in treating urinary incontinence associated with urinary frequency, urgency, and nocturnal enuresis.

Anticholinergic agents inhibit the binding of acetylcholine to the cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. In addition, they increase the urine volume at which first involuntary bladder contraction occurs, decrease the amplitude of the involuntary bladder contraction, and may increase bladder capacity.

All anticholinergic drugs have a similar performance profile and toxicity. Potential adverse effects of all anticholinergic agents include blurred vision, dry mouth, heart palpitations, drowsiness, and facial flushing. When anticholinergic drugs are used in excess, the bladder may go into acute urinary retention.

All drugs with anticholinergic effects or side effects are contraindicated if patients have documented narrow-angle glaucoma. Wide-angle glaucoma is not a contraindication to their use.

Other contraindications to anticholinergic use are urinary retention, bowel obstruction, ulcerative colitis, myasthenia gravis, and severe heart diseases. Because of the potential for drowsiness—especially when combined with alcohol, sedatives, or hypnotic drugs—these agents may impair the patient's ability to perform hazardous activities, such as driving or operating heavy machinery.

Dicyclomine hydrochloride (Bentyl)

An anticholinergic agent with smooth muscle relaxant properties, dicyclomine blocks the action of acetylcholine at parasympathetic sites in secretory glands and smooth muscle.

Darifenacin (Enablex)

Darifenacin is an extended-release product eliciting competitive muscarinic receptor antagonistic activity. It reduces bladder smooth muscle contractions. Darifenacin has high affinity for M3 receptors involved in bladder and GI smooth muscle contraction, saliva production, and iris sphincter function. It is indicated for overactive bladder with symptoms of urge incontinence, urgency, and frequency. Swallow whole; do not chew, divide, or crush.

Solifenacin succinate (VESIcare)

Solifenacin elicits competitive muscarinic receptor antagonist activity, which results in anticholinergic effects and inhibition of bladder smooth muscle contraction. This agent is indicated for overactive bladder with symptoms of urgency, frequency, and urge incontinence. It must be swallowed whole; do not crush or chew.

Hyoscyamine sulfate (Levsin/SL, Levsin, Levsinex, Cystospaz-M, Levbid)

Hyoscyamine blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS, which in turn has antispasmodic effects. Hyoscyamine is absorbed well by the GI tract. Food does not affect absorption of this drug. Hyoscyamine is available in sublingual form (Levsin SL, Symax SL), conventional tablets (Levsin), and extended-release tablets (Levbid).

Propantheline (Pro-Banthine)

A prototypical anticholinergic agent, propantheline blocks action of acetylcholine at postganglionic parasympathetic receptor sites.

Tolterodine (Detrol and Detrol LA)

Competitive muscarinic receptor antagonist for overactive bladder. However, it differs from other anticholinergic types in that it has selectivity for urinary bladder over salivary glands. Exhibits a high specificity for muscarinic receptors, has minimal activity or affinity for other neurotransmitter receptors and other potential targets such as calcium channels. In clinical studies, the mean decrease in urge incontinence episodes was 50% and the mean decrease in urinary frequency was 17%. The mean decrease in urge incontinence episodes per wk was 53% for Detrol LA 4 mg qd.

Trospium (Sanctura)

Quaternary ammonium compound that elicits antispasmodic and antimuscarinic effects. Antagonizes acetylcholine effect on muscarinic receptors. Parasympathetic effect reduces smooth muscle tone in the bladder. Indicated to treat symptoms of overactive bladder (eg, urinary incontinence, urgency, frequency).

Fesoterodine (Toviaz)

Competitive muscarinic receptor antagonist. Antagonistic effect results in decreased bladder smooth muscle contractions. Indicated for symptoms of overactive bladder (eg, urinary urge incontinence, urgency, and frequency). Available as 4- or 8-mg extended-release tab.

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