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Thread: Oxybutinin is saving my public life but...my neuro told me of this danger.

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    Distinguished Community Member Lazarus's Avatar
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    Default Oxybutinin is saving my public life but...my neuro told me of this danger.

    I have had big troubles with bladder control. I took oxy for 25 years..one pill a day...and it was perfect. When things got worse I tried lots of alternatives, eventually Botox, and nothing worked. When I started to take two 5 mg. Oxybutinin at once instead of just one, control was reestablished. Great. Then my neuro made me aware of this danger. Oops.

    Concern over high US prescribing levels of common drug linked to dementia
    Date:
    March 27, 2017
    Source:
    European Association of Urology
    Summary:
    A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder (27.3%), even though other more suitable drugs are available.
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    A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder (27.3%), even though other more suitable drugs are available. This work is presented at the European Association of Urology conference in London, where concerns are also being expressed about the lack of funded alternatives to oxybutynin in Europe.

    Overactive bladder (OAB) is extremely common in persons over 65. Initial treatment is normally via behavioural modifications, which can then be followed by first-line medical treatment such as antimuscarinic medications, including oxybutynin. Antimuscarinic drugs are synthetic compounds, originally derived from mushrooms, which block the activity of the muscarinic acetylcholine receptor. They have several uses, including control of OAB. Oxybutynin is the least expensive antimuscarinic used for OAB, and so tends to be the drug of choice for health care plans such as Medicare. However, a body of evidence has shown that oxybutynin is linked to greater cognitive decline in the elderly ref1.

    An international group of clinicians, led by Dr Daniel Pucheril (Vattikuti Urology Insitute, Henry Ford Hospital, Detroit), looked at evidence from the National Ambulatory Medical Care Survey, where 1,968 patients had received antimuscarinic medications. They found that oxybutynin was prescribed to 27.3% of patients aged over 65 receiving a new antimuscarinic prescription for OAB. Additionally, despite the United States Food and Drug Administration recommendation that patients starting oxybutynin be closely monitored for adverse central nervous system side effects, the authors found that only 9% of elderly persons received a neurologic exam at the time of drug prescription.

    Around 16% of US adults suffer from overactive bladder, which translates into tens of millions of sufferers in the US.

    According to Dr Pucheril, "We looked at a representative sample, but when you extrapolate to the US population the figures are huge. We estimate that over the six years of our analysis, 47 million individuals in the USA were taking various types of antimuscarinic drugs for OAB, with around 55% of new prescriptions going to the over 65's.

    After lifestyle modifications, antimuscarinic medications constitute the most common first line therapies. In the United States, the majority of elderly persons are insured by Medicare. Medicare insurance plans have often have tiered medication formularies to minimize drug expenses. Oxybutynin is the least expensive antimuscarinic drug available, but its pharmacologic properties may cause significant cognitive side effects in elderly persons. Despite evidence of these side effects, physicians are not commonly checking for cognitive effects in those using these medications."

    Dr Pucheril continued "We're not saying that everyone should change from oxybutynin to another drug -- it still has its uses, and coming off the drug without medical supervision is not recommended. Nevertheless, doctors need to look closely at the levels of prescribing. More than anything else, the funding bodies have to make it easier for doctors to prescribe newer antimuscarinics which are much less likely to cause cognitive dysfunction."

    Commenting, on the European situation, Professor Helmut Madsbacher (Innsbruck) said: "This new work from the US highlights a more general problem which also exists here in Europe. In Europe, oxybutynin use varies from country to country. What we find is that where a range of antimuscarinic drugs is funded, as for example happens in Germany, Austria and Switzerland, then oxybutynin use is low, at around 5% to 7%, for obvious reasons. However, in some countries only oxybutynin is funded, and this creates a problem. For example, the only antimuscarinic funded by Italian health Authorities is oxybutynin, and this leads to some areas with around 70% of antimuscarinic prescriptions being oxybutynin."

    Professor Andrea Tubaro (Sapienza UniversitÓ, Roma) added: "If an alternative drug is not funded by the health system then it becomes too expensive for a patient to buy themselves. In Italy generic oxybutynin costs around €5/month, but someone wishing to pay for a different antimuscarin or an up-to-date alternative such as a beta3 agonist will end up paying around €50/month. Even in strictly economic terms, there's no sense in saving a few Euros on a drug which risks worsening dementia, one of the most costly conditions which medicine can treat. This is a problem in Italy, but funders in all countries really need to support the use of a range of drugs."

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    Materials provided by European Association of Urology. Note: Content may be edited for style and length.
    Last edited by Lazarus; 06-07-2019 at 01:50 PM.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"


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    Distinguished Community Member Cherie's Avatar
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    Thanks for sharing.

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    Distinguished Community Member agate's Avatar
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    There's a whole boatload of drugs we might want to avoid taking if we're getting older. Just about every bladder-control drug is on the list--including Vesicare, which seems to be preferred by many now:

    https://www.health.harvard.edu/mind-...-of-your-brain
    i don't trip--I do random gravity checks.

    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member Lazarus's Avatar
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    Quote Originally Posted by agate View Post
    This quote is hidden because you are ignoring this member. Show Quote
    There's a whole boatload of drugs we might want to avoid taking if we're getting older. Just about every bladder-control drug is on the list--including Vesicare, which seems to be preferred by many now:

    https://www.health.harvard.edu/mind-...-of-your-brain
    Oh! Thank you for the link.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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    Distinguished Community Member SuzE-Q's Avatar
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    Yes, we've discussed the anticholinergic burden here, including bladder meds.

    That's why I recently switched to mirabegron for bladder control. I'm pretty sure I mentioned it here. It's a nonanticholinergic alternative. My neuro ok'd it.
    Please Note that my posts may have been arbitrarily altered by a Moderator and may not reflect my original content.

    Per Mike Weins: "...the admin/mod team doesn't have to provide a forewarning/warning/mention about altering a members post. It doesn't matter if they fix a link, remove a link, fix a typo, or whatever...."

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    Both of these articles are interesting and alarming. Agate, the one Linda posted stated that there are newer bladder drugs out there. I wonder if they are newer than what is on your list.
    Virginia

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    Distinguished Community Member Lazarus's Avatar
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    In the article Agate posted it mentioned problems were linked to the dosage taken. 5mg used to give me 8 hours of total control. Now I use 10mg for the same affect. The maximum dosage allowed per day is recommended to be 20mg. Not sure what this means for me...

    And I never take it every day...I use it when going out or when wanting to work outside for a long time. I will research mirabegron. Oops ...just looked it up and when I saw the common name I realized it was one of the new ones I tried this year which did not work for me.
    Last edited by Lazarus; 06-07-2019 at 04:02 PM.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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    Distinguished Community Member SuzE-Q's Avatar
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    Linda,

    Here is where you brought this up, and I replied to you about this back in March:

    http://www.braintalkcommunities.org/...arch-Chit-Chat
    Please Note that my posts may have been arbitrarily altered by a Moderator and may not reflect my original content.

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    Distinguished Community Member SuzE-Q's Avatar
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    Quote Originally Posted by Lazarus View Post
    This quote is hidden because you are ignoring this member. Show Quote
    In the article Agate posted it mentioned problems were linked to the dosage taken. 5mg used to give me 8 hours of total control. Now I use 10mg for the same affect. The maximum dosage allowed per day is recommended to be 20mg. Not sure what this means for me...

    And I never take it every day...I use it when going out or when wanting to work outside for a long time. I will research mirabegron. Oops ...just looked it up and when I saw the common name I realized it was one of the new ones I tried this year which did not work for me.
    Oops, I think we were posting at the same time.

    Can you try a higher dose of that one, is there an acceptable range?
    Please Note that my posts may have been arbitrarily altered by a Moderator and may not reflect my original content.

    Per Mike Weins: "...the admin/mod team doesn't have to provide a forewarning/warning/mention about altering a members post. It doesn't matter if they fix a link, remove a link, fix a typo, or whatever...."

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    Distinguished Community Member agate's Avatar
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    Looks as if mirabegron first got FDA approval in 2012. It may be a great improvement over the previous remedies. Hope so.
    Last edited by agate; 06-07-2019 at 04:39 PM.
    i don't trip--I do random gravity checks.

    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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