AM act mainly by blocking M3 receptors; Because there are no AM with significant selectivity for the bladder, adverse effects (AEs) of treatment are common;
AM differ in molecular size, charge and lipophilicity; Quaternary AM have greater molecular charge and less lipophilicity which limit their passage into the central nervous system;
Many AM are metabolized by the P450 enzyme system which may affect the plasma concentration of the AM and that of an interacting drug;
All commercially available AM improve OAB symptoms and quality of life with comparable efficacy, but different tolerability profiles;
The most frequent AEs are gastrointestinal, with dry mouth as the most common;
Considering the starting oral dosages, a similar AE profile was observed for most AM, with the exception of oxybutynin which demonstrated higher AE rates;
Immediate-release AM have a greater risk of side effects than extended-release formulations;
Recommended AM dosages do not significantly inhibit voiding contraction;
AM should be avoided in the elderly population since the cumulative use of medications with anticholinergic activity may be associated with the risk of dementia;
Persistence in treatment with AM is low, with only 20% persisting after 1 year;
Due to specific pharmacologic properties and dosing schedule, AM treatment must be individualized;
Intravesical administration of oxybutynin is an option for patients with neurogenic dysfunction who perform intermittent catheterization.
