Columbia University, 11th Floor, HIP, 161 Ft. Washington Avenue, New York, NY, 10032, USA.
School of Pharmacy, Department of Pharmacy, University of Washington, Seattle, WA, USA.
Clin Drug Investig. 2021 Apr;41(4):293-302. doi: 10.1007/s40261-021-01020-x. Epub 2021 Mar 12.
Overactive bladder (OAB) is a common disorder in the general population, and the prevalence increases with age. Adults with OAB typically have a greater number of comorbid conditions, such as hypertension, depression, and dementia, compared with adults without OAB. Subsequent to an increased number of comorbidities, adults with OAB take a greater number of concomitant medications, which may increase the risk of potentially harmful drug‒drug interactions. There are two important considerations for many of the medications approved for the treatment of OAB in the USA: anticholinergic burden and potential for drug‒drug interactions, notably related to cytochrome P450 (CYP) 2D6, which is responsible for the metabolism of approximately 25% of all drugs. A substantial number of drugs used for the treatment of OAB and comorbid conditions (e.g., cardiovascular and neurologic disorders) are CYP2D6 substrates or inhibitors. Furthermore, a substantial number of drugs with CYP2D6 properties also have strong anticholinergic properties. Here, we review polypharmacy associated with OAB and its common comorbidities, identify drugs with reported anticholinergic properties, and provide an overview of clinically relevant drug‒drug interactions in the treatment of OAB as they relate to CYP2D6 metabolism. This review aims to provide clinicians with essential information necessary for making treatment decisions when managing OAB.
膀胱过度活动症（OAB）是一种常见的普通人群疾病，其患病率随着年龄的增长而增加。与无 OAB 的成年人相比，患有 OAB 的成年人通常有更多的合并症，如高血压、抑郁症和痴呆症。由于合并症的数量增加，患有 OAB 的成年人会同时服用更多的伴随药物，这可能会增加潜在有害的药物相互作用的风险。在美国，有两种药物获批用于治疗 OAB，这两种药物有两个重要的考虑因素：抗胆碱能负担和药物相互作用的潜力，特别是与细胞色素 P450（CYP）2D6 相关，它负责代谢大约 25%的所有药物。用于治疗 OAB 和合并症（如心血管和神经疾病）的许多药物是 CYP2D6 的底物或抑制剂。此外，许多具有 CYP2D6 特性的药物也具有很强的抗胆碱能特性。在这里，我们回顾了与 OAB 及其常见合并症相关的多种药物治疗，并确定了具有报道的抗胆碱能特性的药物，并概述了与 CYP2D6 代谢相关的 OAB 治疗中临床相关的药物相互作用。本综述旨在为临床医生在管理 OAB 时做出治疗决策提供必要的基本信息。
