Choosing Wisely:

Avoid using anticholinergic medication to treat overactive bladder in women older than 70 years.

Rationale and Comments: Anticholinergic medications block acetylcholine at muscarinic receptors, which are present throughout the body. These medications have many side effects, including impaired cognition, drowsiness, and constipation. Several cohort studies have raised concern regarding an association between higher exposure to anticholinergics and increased risk of dementia. Given this, beta-3 agonists or third-line therapies should be preferentially utilized when possible. When anticholinergics cannot be avoided, the lowest effective dose of anticholinergic should be used, and consideration should be given to decreasing the dose of other concurrent anticholinergic medications.
Sponsoring Organizations:
  • American Urogynecologic Society
  • Sources:
  • Expert consensus
  • Disciplines:
  • Urologic
  • Geriatric Medicine
  • References: • AUGS consensus statement: Association of Anticholinergic Medication Use and Cognition in Women with Overactive Bladder. Female Pelvic Med Reconstr Surg. 2017;23(3):177-178.
    • Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401-407.
    • Risacher SL, McDonald BC, Tallman EF, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol. 2016;73(6):721-732.
    • Richardson K, Fox C, Maidment I. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018 Apr 25;361:k1315.
    • Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019;179(8):1084-1093.
    • Welk B, McArthur E. Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU Int. 2020;126(1):183-190.
    • Wang YC, Chen YL, Huang CC. Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study. BMC Geriatr. 2019;19(1):380.
    • Andre L, Gallini A, Montastruc F. Association between anticholinergic drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review. Eur J Clin Pharmacol. 2019;75(12):1631-1644.

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