New Guidance for Reducing Medication-Related Dementia Risk in Patients With Overactive Bladder

A recent white paper published by the Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) advises of an increased risk of dementia associated with the prolonged use of anticholinergic medications in patients with overactive bladder (OAB) and provides practical clinical guidance for reducing that risk.

“As more data is becoming available, there are increasing concerns about the long-term use of anticholinergic medications and dementia risk,” said the paper’s coauthor Anne M. Suskind, MD, MS, FACS, FPM-RS, chief of Neurourology and Female Pelvic Medicine and Reconstructive Surgery at UCSF. “This consensus paper is designed to update urologists and other health care providers who prescribe anticholinergics about the risks of these medications and help guide them on when to use anticholinergics and when it is appropriate to use alternatives.”

Six principles of care

The SUFU committee of subject matter experts, including Suskind, reviewed the current body of literature on anticholinergics for OAB. “We built consensus around six principles of care that we felt were good tenets to help guide the use of these medications,” she said.

  1. Chronic use – more than three months – of OAB anticholinergic medications is likely associated with an increased risk of new-onset dementia.
  1. Short-term use – less than four weeks – of OAB anticholinergic medications is likely safe in most individuals.
  1. When pharmacologic therapy is indicated for OAB, a trial of beta-3 agonists is typically preferred before an OAB anticholinergic medication.
  1. When OAB anticholinergics are indicated, oxybutynin IR should be avoided, and alternatives with more favorable neuropharmacological profiles, such as extended-release formulations of trospium, darifenacin and fesoterodine, are preferred.
  1. Clinicians should consider potential cognitive risks in all patient populations when prescribing OAB anticholinergics for chronic use.
  1. Consideration should be given to progressing to advanced therapy, such as botulinum toxin or neuromodulation, earlier in the OAB treatment paradigm.

Shared decision-making

The white paper emphasizes that the increased dementia risk should be weighed against the potential benefits of anticholinergics, and decisions on their use should be shared between clinician and patient.

“Many patients don’t want to risk cognitive side effects, but a lot of insurance companies won’t cover other treatments unless anticholinergics are tried first,” Suskind said. “Hopefully publications like this will help to move the needle so that more people can try other OAB therapies when they want to.” 

 

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UCSF Urology Practice

Phone: (415) 353-2200 | Fax: (415) 353-2641

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UCSF Women’s Center for Bladder & Pelvic Health

Phone: (415) 353-2200 | Fax: (415) 353-2641

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