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A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder (27.3%), even though other more suitable drugs are available. This work is presented at the European Association of Urology conference in London, where concerns are also being expressed about the lack of funded alternatives to oxybutynin in Europe.

Overactive bladder (OAB) is extremely common in persons over 65. Initial treatment is normally via behavioural modifications, which can then be followed by first-line medical treatment such as antimuscarinic medications, including oxybutynin. Antimuscarinic drugs are synthetic compounds, originally derived from mushrooms, which block the activity of the muscarinic acetylcholine receptor. They have several uses, including control of OAB. Oxybutynin is the least expensive antimuscarinic used for OAB, and so tends to be the drug of choice for health care plans such as Medicare. However, a body of evidence has shown that oxybutynin is linked to greater cognitive decline in the elderly ref1.

An international group of clinicians, led by Dr Daniel Pucheril (Vattikuti Urology Insitute, Henry Ford Hospital, Detroit), looked at evidence from the National Ambulatory Medical Care Survey, where 1,968 patients had received antimuscarinic medications. They found that oxybutynin was prescribed to 27.3% of patients aged over 65 receiving a new antimuscarinic prescription for OAB. Additionally, despite the United States Food and Drug Administration recommendation that patients starting oxybutynin be closely monitored for adverse central nervous system side effects, the authors found that only 9% of elderly persons received a neurologic exam at the time of drug prescription.

Around 16% of US adults suffer from overactive bladder, which translates into tens of millions of sufferers in the US.