Chancellor Michael B, de Miguel Fernando
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Geriatrics. 2007 May;62(5):15-24.
Overactive bladder (OAB) is highly prevalent in the older population and decreases quality of life. Current therapy consists primarily of anticholinergic drugs. Because older individuals typically take multiple medications, clinicians must pay special attention to potential drug-drug interactions that may cause adverse events or alter drug efficacy. The most clinically important drug-drug interactions occur during cytochrome P450 (CYP450) isoenzyme metabolism, resulting in altered metabolism of one or more of the coadministered agents. Of the drugs indicated for OAB, tolterodine, darifenacin, solifenacin, and oxybutynin are extensively metabolized by CYP450, but trospium is not. Trospium is eliminated as unchanged drug, suggesting that it has lower potential for drug-drug interactions and may, therefore, represent a safer treatment option for OAB, particularly in the context of polypharmacy, a significant concern in older adults.
膀胱过度活动症（OAB）在老年人群中非常普遍，会降低生活质量。目前的治疗主要包括抗胆碱能药物。由于老年人通常服用多种药物，临床医生必须特别注意可能导致不良事件或改变药物疗效的潜在药物相互作用。临床上最重要的药物相互作用发生在细胞色素P450（CYP450）同工酶代谢过程中，导致一种或多种共同给药药物的代谢改变。在用于治疗OAB的药物中，托特罗定、达非那新、索利那新和奥昔布宁通过CYP450广泛代谢，但曲司氯铵不是。曲司氯铵以原形药物形式消除，这表明它发生药物相互作用的可能性较低，因此可能是治疗OAB的更安全选择，特别是在多重用药的情况下，这是老年人的一个重要问题。
