Which is used in overactive bladderaEUR'
Darfinacin; 'C' i.e., Flavoxate; `d' i.e., Oxybutynin Detrusor instability (Overactive bladder) Detrusor is a smooth muscle which forms the body of the bladder. Its contraction causes micturition. The other smooth muscle that plays an impoant role in micturition is the internal sphincter. Internal sphincter is a concentraction of smooth muscle at the bladder neck. It is well developed only in males and its principal. function is to prevent retrograde .flow of semen during ejaculation. When detrusor relaxes and the sphincters close urine is stored. Whereas voiding requires contraction of destrusor accompanied by relaxation of sphincters. Detrusor is innervated mainly by parasympathetic nerves which are excitatory and cause the muscle to contract where as internal sphincter is rich in aI adrenoreceptor (sympathetic nerves). Thus the mechanisms of urine voiding involves:? - Increased parasympathetic drive Contracts the detrusor - Decreased sympathetic drive Relax the sphincter Detrusor instability or unstable bladder is characterized by uninhibited, unstable contractions of the detrusor which may be of unknown etiology or secondary to an upper motor neuron lesion or bladder neck obstruction. Since detrusor contracts under parasympathetic influence, Anticholinergic (specifically antimuscarinic) drugs are used to treat overactive bladder disease or detrusor instability. These agents lower intravesical pressure, increase capacity and reduce the frequency of contractions by antagonizing para.sympa- thetic control of bladder. These agents include: ? - Darifenacin - Solefenacin - Tolterodine - Trospium chloride - Oxybutynin - Solifenacin - Flavoxate Duloxetine is used in stress incontinence. It is a dual norepinephrine and serotonin reuptake inhibitor. Its mechanism of action is thought to be centrally, by increasing urethral sphincter tone and contractility. It can be used in mixed incontinence. Comparison of different drugs used for treatment of Detrusor instability Drug Benefits Weaknesses * Generic oxvbutynin - Cheap - Recommended by NICE well established Poorly tolerated * Slow release oxybutynin - Improved side-effect profile - Escalating does regimen possible More expensive than immediate release * Oxyhutynin patches - Reduced side - effect profile Patches may cause skin Irritation limiting use * Flavoxate - Less side effects than Oxybutinn i Less offecting * Tolterodine - First of newer anticholinergics - Robust trial evidence Trial suggests not as effective as olifenacin * Trosplum - Does not cross blood- brain barrier - May have benefits in the elderly or patients with polypharmacy Broad spectrum anticholinergic side effects * Propiverine - Calcium antagonist action Recommended for frequency but not urge incontinence * Solifenacin - STAR study suggests some benefits over tolterodine at normal does Commonest side effect-dry mouth * Darifenacin - M3 selective Limited direct clinical experience outside of trials
Duloxetine
Darfinacin
Flavoxate
Oxybutynin