Autonomic Nervous Systems
DOC for hyperactive bladder is: (DNB Dec 2009)
a. Tolterodine is a selective M3 antagonist and is considered to be the drug of choice for hyperactive bladder.
b. This condition is characterized by frequent and involuntary urination. The drug is better tolerated than oxybutynin. Fesoterodine is a related drug with similar activity.
c. Oxybutynin is somewhat selective for M3 receptors and is used to treat bladder spasm after prostate surgery. It is also used in children with neurological diseases e.g. meningomyelocele.
d. The drug could be used orally or injected in bladder to reduce risk of renal infection or damage. It has also been used transdermally to reduce the need of multiple dosing owing to its short half life.
e. Trospium is another such drug with similar efficacy and comparable side effects. Darifenacin or solifenacin are recently approved antagonists with comparable efficacy.
f. Botulinum toxin type A is also injected in bladder and has comparable efficacy. This drug relieves bladder spasm and is used in urinary incontinence refractory to other treatment options.
S - Solefenacin
O - Oxybutynin
F - Flavoxate, Fesoterodine
T - Tolterodine, Trospium
bladDAR – DARifenacin
Overactive bladder is treated by making it soft bladder.