Editing AUA: Overactive Bladder (2019) (section)

===== Adverse events (9) =====
#'''<span style="color:#ff0000">Dry mouth (20-40%)</span>'''
#'''<span style="color:#ff0000">Constipation (7-9%)</span>'''
#'''<span style="color:#ff0000">Dry or itchy eyes</span>'''
#'''<span style="color:#ff0000">Blurred vision</span>'''
#'''<span style="color:#ff0000">Dyspepsia</span>'''
#'''<span style="color:#ff0000">UTI</span>'''
#'''<span style="color:#ff0000">Urinary retention</span>'''
#'''<span style="color:#ff0000">Impaired cognitive function</span>'''
#'''<span style="color:#ff0000">Arrhythmias (rare)</span>'''
*'''<span style="color:#ff0000">Dry mouth</span>'''
**<span style="color:#ff0000">'''Dry mouth rates for oxybutynin (61%) significantly higher''' </span>than tolterodine (24%)
**'''<span style="color:#ff0000">If an immediate release (IR) and an extended release (ER) formulation are available, then ER formulations should preferentially be prescribed over IR formulations because of lower rates of dry mouth.</span>'''
*** ER formulations of oxybutynin and tolterodine result in significantly fewer patient reports of dry mouth than the IR formulations of either medication.
***Compliance with a once-daily treatment has been shown to be greater than with medications that are taken more than once a day
**<span style="color:#ff0000">'''Management'''</span>
***<span style="color:#ff0000">'''Can be mitigated with (4):'''</span>
***#<span style="color:#ff0000">'''Oral lubricants'''</span>
***#<span style="color:#ff0000">'''Small sips of water'''</span>
***#<span style="color:#ff0000">'''Sucking on sugar-free hard candies and chewing sugar-free gum'''</span>
***#<span style="color:#ff0000">'''Avoiding mouthwashes with alcohol'''</span>
***<span style="color:#ff0000">'''Transdermal preparations of oxybutynin may be offered instead of oral anti-muscarinics to patients who are at risk of or who have experienced dry mouth with oral agents'''</span>
****<span style="color:#ff0000">'''The use of transdermal anti-muscarinics should be monitored to ensure that the skin where the medication is applied remains intact.''' </span>
*'''<span style="color:#ff0000">Constipation</span>'''
**<span style="color:#ff0000">'''Can be mitigated with'''</span> 
***<span style="color:#ff0000">'''Adequate dietary fiber and fluid'''</span>
***<span style="color:#ff0000">'''Psyllium-based fiber supplements'''</span>
***<span style="color:#ff0000">'''Regular exercise and normal bowel habits.'''</span>
**<span style="color:#ff0000">'''Constipation rate significantly higher for darifenacin (17%) and oxybutynin (12%)</span>''', compared to tolterodine (5%)
*'''<span style="color:#ff0000">Constipation and dry mouth should be managed before abandoning effective anti-cholinergic therapy.</span>'''
**'''<span style="color:#ff0000">Management may include bowel management, fluid management, dose modification or alternative anti-cholinergics.</span>'''
*'''<span style="color:#ff0000">Cognitive impairment</span>'''
**Patients may not recognize that memory deterioration has occurred, making it essential for the clinician, family members and caregivers to monitor for these effects
**While newer agents (eg, darifenacin) are reported to be less likely to produce cognitive deficits in elderly patients, the literature is limited; the two-week drug administration period in these studies is not long enough to yield definitive conclusions.