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Antimuscarinics

Antimuscarinics are drugs prescribed to treat urinary incontinence. There are different medications available via prescription and over the counter. 

  1. Treats urinary incontinence.
  2. Prescribed when bladder training or pelvic floor exercises have proven ineffective.
  3. Usually administered orally via tablets. 

If you are concerned about symptoms you are experiencing relating to urinary incontinence, you can speak with one of our registered clinicians via our online video consultation service. They are available from 9.30am to 4.30pm, Monday to Friday.

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Product information

What are antimuscarinics?

Antimuscarinics are medications that typically come in tablet form and are prescribed to treat urinary incontinence. They are usually prescribed when non-medicinal treatments have failed to provide any relief from the condition.

What is urinary incontinence?

Urinary incontinence is described as unintentional urination and is a relatively common complaint in the UK, with millions thought to experience it to some degree. It can be divided into four categories: stress incontinence, urge incontinence, overflow incontinence and total incontinence. The stress and urge types may present at the same time.

Stress incontinence arises at times when you put pressure on your bladder; for instance, through sneezing or coughing. Urge incontinence occurs when urine leaks and you experience an overwhelming urge to go to the bathroom, either at the same time or soon afterwards. Overflow incontinence (sometimes referred to as chronic urinary retention) occurs when you are unable to empty the bladder when urinating, leading to leakage throughout the day. Total incontinence is an inability to store urine in the bladder, leading to frequent urination and leaking.

What causes urinary incontinence?

The causes of urinary incontinence depend on the type of incontinence in question. For example, stress incontinence is typically caused by a weakening of, or damage to, the pelvic floor muscles. This can be due to damage during childbirth, surgery, neurological issues and medications. The main cause of urge incontinence is a weakening of a muscle that allows the bladder to fill with urine called the detrusor muscle. By contracting too often, this can lead to having an overactive bladder. Drinking too much caffeine or alcohol, dehydration, constipation, infections and medications can all trigger the condition.

Overflow incontinence is usually caused by a blockage, such as constipation, an enlarged prostate or bladder stones. This type of incontinence can also lead to issues with the detrusor muscle that is described above in cases of urge incontinence. 

Total incontinence, the most severe type, is generally triggered by one of three causes, although this by no means covers all possible sources. Birth defects are one of the most common, resulting in the condition being present from birth. Injury to the spinal column leading to nerve damage is another common trigger, as well as fistula of the bladder, which is a hole that can form in an area close by, such as the vagina. 

Besides these specific causes, some risk factors may also play a part in triggering incontinence, including a family history (which suggests that there is a genetic component) and age. 

How is urinary incontinence treated?

Treatment for incontinence can be divided into three categories, lifestyle changes and practices, medication and surgery. Lifestyle changes can be of great benefit for many, avoiding many of the issues associated with medication and surgery. These include avoiding caffeine and alcohol, not consuming too much or too little fluid, and losing weight. Pelvic floor exercises may also be useful. This involves strengthening the muscles around the bladder and urethra by contracting these muscles daily. Electrical stimulation may be used in order to help you achieve this, as well as vaginal cones, which involves inserting small weights into the vagina.

Bladder training is another method by which you can avoid more invasive treatments, particularly for urge incontinence. This involves increasing the time between the urge to urinate and actual urination. A bladder training course lasts for around six weeks and is available through the NHS.

What treatments are available for urinary incontinence?

Incontinence medications come in different forms, and the most suitable one for you will depend on the type of incontinence you are experiencing. If lifestyle changes and practices have not proven to be effective for stress incontinence, surgery is often the next step, although some medications, such as Duloxetine, may be suggested. 

There are a number of antimuscarinic medications that can be used to control symptoms of urge incontinence, such as oxybutynin, tolterodine and darifenacin. They are usually available in tablet form, but patches for oxybutynin are also available. 

If antimuscarinics are unsuitable for you, mirabegron may be suggested, which helps the bladder relax and relieves many of the symptoms. If medication has proven to also be ineffective, then surgery will be offered, although you will need to weigh up the pros and cons of this with your doctor.

If you would like to discuss incontinence with a doctor, our GPhC-registered clinicians are available via our online video consultation service. You can book an appointment with them between 9.30am-4.30pm, five days a week. They can also provide fit notes and referral to specialists for treatment, where suitable.  

Page last reviewed:  24/06/2020
Side effects and warnings

What side effects can antimuscarinics cause?

It depends on the medication that you’re using. The following side effects relate to tolterodine. For more information about any side effects related to the medication you’re taking, you should consult the patient information leaflet that comes with your medication. You should also discuss any concerns you have with your prescribing doctor before starting treatment.

Stop taking this medication and seek immediate medical assistance if you experience any of the following symptoms: swollen face, tongue or pharynx, difficulty swallowing, hives, difficulty breathing, chest pain, difficulty breathing or getting tired when at rest and swelling of the legs. 

Other side effects include: 

Very common (occur in more than 1 in 10 patients): dry mouth and headaches. 

Common (occur in less than 1 in 10 patients): bronchitis, dizziness, sleepiness, dry eyes, blurred vision, abdominal pain, spinning sensation, palpitations, dry skin, poor digestion, constipation, tiredness, painful or difficult urination, increased weight, chest pain, vomiting, inability to empty the bladder, diarrhoea, pins and needles, bloating and swelling of the ankles.

Uncommon (occur in less than 1 in 100 patients): allergic reactions, nervousness, irregular heartbeat, heart failure, heartburn and memory loss.

Are antimuscarinics safe to use with other treatments? 

If you are currently taking, or have recently taken, other medications, including supplements, you should inform your doctor before starting treatment with antimuscarinics.

In the case of tolterodine, the following medications should not be taken alongside it: certain antibiotics, antifungals and some medicinal products used in the treatment of HIV. 

The following treatments should be used with caution when taken alongside tolterodine: medicines that affect the passage of food, treatment for an irregular heartbeat, other antimuscarinics, certain antihistamines, phenothiazine antipsychotics and tricyclic antidepressants. 

Antimuscarinics may also inhibit the absorption of other medications.

Warnings and precautions when using antimuscarinics

Your doctor should be informed about any other conditions you suffer from or are prone to before starting treatment with any prescription medication. You should not use tolterodine if any of the following applies to you: an allergy to any of its ingredients, if you cannot pass urine at all, if you have uncontrolled narrow angle glaucoma, myasthenia gravis, severe ulcerative colitis or toxic megacolon.

This treatment should be used with caution if you have difficulties passing urine, a poor stream of urine, gastro-intestinal disease, kidney problems, liver conditions, neuronal disorders that affects blood pressure, bowel or sexual function, hiatal hernia, severe constipation, abnormal heart tracing, bradycardia, cardiomyopathy, myocardial ischaemia, arrhythmia, heart failure or low levels of potassium, calcium hypocalcaemia and magnesium.

Antimuscarinics and pregnancy 

For information about the medication you have been prescribed, you should refer to the patient information leaflet provided with your treatment, or consult your prescribing clinician. 

You should not take tolterodine whilst you are pregnant, and you should tell your doctor if you are pregnant, are planning on becoming pregnant or think you might be pregnant so that the right treatment can be prescribed. 

It’s unclear as to whether this medication is passed on through breast milk, and so you should avoid taking it whilst breastfeeding.

Page last reviewed:  24/06/2020
Questions and Answers

Will antimuscarinics affect my ability to drive?

Antimuscarinics may cause dizziness, fatigue and altered vision. Before operating any heavy machinery, you should be sure how this medication affects you. 

Should antimuscarinics be taken with or without food?

Tolterodine can be taken with or without food. For other treatments, you should consult the patient information leaflet that comes with your medication, or speak to your prescribing clinician. 

Are antimuscarinics available to buy over the counter?

Some forms of antimuscarinics are available to buy over the counter from your local pharmacy, such as the patch form of oxybutynin. For other treatments, you will need a prescription.

How can I buy antimuscarinics online?

You can discuss antimuscarinics with one of our GMC-registered clinicians via our online video consultation service. They are available from 9.30am-4.30pm, Monday to Friday. Our registered clinicians can also issue fit notes and referral to specialists for treatment, where appropriate.  

Page last reviewed:  24/06/2020

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