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Extended-release oxybutynin and tolterodine treat overactive bladder

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  • BACKGROUND: Overactive bladder is characterized by symptoms of urgency and frequency with or without involuntary loss of urine (urge incontinence). Overactive bladder negatively affects quality of life.1
  • POPULATION STUDIED: Investigators at 71 US centers enrolled 799 women into this study. Enrollees averaged 21 to 60 urge incontinence episodes per week and 10 or more voids per day. Their average age was 60 years and more than 80% were white. About half of the patients had been treated previously with anticholinergic drugs.
  • STUDY DESIGN AND VALIDITY: Patients were randomly assigned to receive 12 weeks of treatment with extended-release oxybutynin 10 mg/d or extended-release tolterodine 4 mg/d. The patients recorded episodes of urinary urge incontinence, total incontinence, and micturition frequency in diaries at baseline, and during treatment weeks 2, 4, 8, and 12.
  • OUTCOMES MEASURED: The primary endpoint was a reduction in episodes of urge urinary incontinence. Secondary endpoints included total incontinence episodes, micturition frequency, and adverse effects.
  • RESULTS: Both groups of patients experienced a decrease in episodes of urge urinary incontinence from about 37 per week to 11 per week. However, investigators found no difference between the treatment groups. Total incontinence episodes also decreased similarly in the 2 groups, from 43 per week at baseline to 13 per week at study end.


 

PRACTICE RECOMMENDATIONS

Extended-release versions of oxybutynin and tolterodine are similarly effective and tolerable in the treatment of women with overactive bladder. No differences are seen in reduction of weekly episodes of urge incontinence and total incontinence after 3 months of treatment. Extended-release oxybutynin is more effective than extended-release tolterodine in promoting total dryness (no episodes of incontinence) after 12 weeks of treatment. Dry mouth is more common with oxybutynin; however, other side effects are similar.

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