Gibson W, Athanasopoulos A, Goldman H, Madersbacher H, Newman D, Spinks J, Wyndaele J J, Wagg A
Int J Clin Pract. 2014 Sep;68(9):1165-73. doi: 10.1111/ijcp.12447. Epub 2014 Sep 6.
Overactive bladder and urgency incontinence are common and distressing conditions in older people, for which the first-line pharmacological treatment is a bladder antimuscarinic agent. Of these, oxybutynin is often recommended in guidelines, but is associated with a higher incidence of adverse drug effects, and in particular has been suggested to have deleterious cognitive effects. Despite this, guidelines often suggest oxybutynin as first-line treatment, and insurance based healthcare systems often require oxybutynin to be used as a first-line therapy and fail before reimbursement for the cost of newer anticholinergics is authorised. We reviewed the literature of bladder antimuscarinics in older adults, using the headings overactive bladder, urinary frequency, urgency, urge, oxybutynin, antimuscarinic, older, older people, and frail. In general, oxybutynin had a similar efficacy to other anticholinergic drugs, but a higher incidence of adverse drug events, in particular significant yet unnoticed cognitive impairment. We conclude that oxybutynin should not be used in frail older people.
膀胱过度活动症和急迫性尿失禁在老年人中很常见且令人苦恼，对此一线药物治疗是膀胱抗毒蕈碱剂。其中，奥昔布宁在指南中常被推荐，但与药物不良反应的发生率较高相关，特别是有人认为它具有有害的认知影响。尽管如此，指南通常建议将奥昔布宁作为一线治疗，而基于保险的医疗保健系统通常要求将奥昔布宁用作一线治疗，并且在批准报销新型抗胆碱能药物的费用之前不予报销。我们使用“膀胱过度活动症”“尿频”“尿急”“急迫性”“奥昔布宁”“抗毒蕈碱剂”“老年人”“年长人群”和“体弱老年人”等标题对老年人膀胱抗毒蕈碱剂的文献进行了综述。总体而言，奥昔布宁与其他抗胆碱能药物的疗效相似，但药物不良事件的发生率较高，尤其是显著但未被注意到的认知障碍。我们得出结论，体弱的老年人不应使用奥昔布宁。
