Are you on a centrally acting anticholinergic? If yes, you may want to consider stopping it. #ClinicSpeak #BrainHealth #MSBlog #MSResearch
"The study below shows that the drug solifenacin (Vesicare), a so called anti-cholinergic drug of the antimuscarinic class, is effective in reducing contractions of overactive bladders and increasing bladder volume. This results in reduced urinary frequency, urgency, urge incontinence and nocturia (need to pass urine at night). These findings are not new; we have been using solifenacin for years and a large number of pwMS find it helpful."
"What is not covered in this abstract is the real reason why solifenacin (Vesicare) is so much better than oxybutynin (Ditropan) and older generation anticholinergic drug. Oxybutynin crosses the blood brain barrier and enters the brain and blocks brain cholinergic receptors, which impairs cognition. Studies suggest that centrally acting anticholinergics, such as oxybutynin, clips IQ by about 7 IQ points or half a standard deviation. This effect is not trivial given that the majority of people with established MS, and bladder problems, already have cognitive problems. In comparison solifenacin, and the other newer generation anticholinergics, don't cross into the brain to the same extent and therefore have a minimal impact on cognition. Why take a drug that impairs cognition when you can take an alternative that does not?"
"If you are on one of the drugs that has centrally acting anticholinergic effects I suggest you discuss the possibility of stopping the medication, or switching to alternative medication, with your neurologist or family doctor."
AIMS: To investigate the effect on urodynamics of 4 weeks treatment with solifenacin succinate in patients with neurogenic detrusor overactivity (NDO) due to multiple sclerosis (MS) or spinal cord injury (SCI).
METHODS: SONIC was a prospective, multicenter, double-blind, phase 3b/4 study investigating the efficacy and safety of solifenacin 10 mg in patients with NDO due to MS or SCI. Patients (n = 189) were randomized to placebo or active treatment (solifenacin 5 mg, 10 mg or oxybutynin hydrochloride 15 mg) for 4 weeks, after a 2-week, single-blind, placebo run-in period. The primary endpoint was change in maximum cystometric capacity (MCC) from baseline to end of treatment. The primary analysis compared solifenacin 10 mg versus placebo; all other comparisons were considered secondary. Secondary endpoints included changes in urodynamic parameters, patient-reported outcomes, and safety assessments.
RESULTS: In the primary analysis, solifenacin 10 mg significantly improved mean change from baseline MCC versus placebo (P < 0.001) and was associated with improvements in bladder volume at first contraction and at first leak as well as detrusor pressure at first leak. Similar results were obtained for oxybutynin versus placebo. Patient perception of bladder condition significantly improved with solifenacin 10 mg versus placebo (P = 0.041). There was a clear improvement in quality of life (QoL) in the solifenacin arms versus placebo. The overall incidence of adverse events was low.
CONCLUSIONS: In patients with NDO due to MS and SCI, 4 weeks of treatment with solifenacin 10 mg improved urodynamic variables and QoL versus placebo and was well tolerated