Trip Answers

Question answered:31/01/07 Warning! this question is over two years old.

Unfortunately, we cannot answer this question.

 

We searched the NLH Guidelines,TRIP and Medline databases but could find only general information on prescribing anticholinergics to treat incontinence in patients with a history of glaucoma.

 

The BNF states:

 

“Involuntary detrusor contractions cause urgency and urge incontinence, usually with frequency and nocturia. Antimuscarinic drugs reduce these contractions and increase bladder capacity…”

 

“Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy and in those susceptible to angle-closure glaucoma.” [1]

 

The 2004 SIGN guideline on the management of urinary incontinence in primary care notes:

 

“Four antimuscarinics; oxybutynin, tolterodine, tropsium and propiverine are effective in reducing detrusor overactivity and hence urgency and urge incontinence. The drugs depress both voluntary and involuntary detrusor contractions by blocking muscarinic receptors on the bladder
smooth muscle…
The most common side effects of antimuscarinic drugs are dry mouth, blurred vision, abdominal discomfort, drowsiness, nausea and dizziness. Urinary retention is a potentially serious but less common side effect. Oxybutynin immediate release (IR) preparation has the highest incidence of side effects.” [2]

 

Kato et al writing on the management of overactive bladder (OAB) and glaucoma state:

 

“Although anticholinergic drugs can precipitate angle-closure glaucoma by pupillary block, they are not contraindicated in open-angle glaucoma or in angle-closure glaucoma that has already been treated by laser iridotomy. Not all urologists are aware of this difference, at least in Japan. Some urologists avoid anticholinergics in all patients with glaucoma, while others pay little attention to glaucoma. Routine history taking and referral to ophthalmologists allows many patients with OAB and glaucoma to benefit safely from anticholinergics. Moreover, clinicians should be aware of patients with OAB who have not been evaluated by ophthalmologists but who are at risk of angle-closure glaucoma.” [3]

 

Given the lack of information on this issue, the NLH Q & A would recommend discussing this case with a local specialist. Alternatively, the NLH Q & A Service can forward this query to a specialist medical information service. Should you wish us to refer this query on your behalf, please let us know via the ‘Contact Us’ option on the website at: http://www.clinicalanswers.nhs.uk/index.cfm?action=contact

 

References
1. BNF No. 52. (http://www.bnf.org/bnf/bnf/52/4630.htm?q=%22urinary%22%22incontinence%22).
2. SIGN. Management of urinary incontinence in primary care. December 2004. (http://www.sign.ac.uk/pdf/sign79.pdf).
3. Kato K, Yoshida K, Suzuki K et al. Managing patients with an overactive bladder and glaucoma: a questionnaire survey of Japanese urologists on the use of anticholinergics. BJU Int. 2005 Jan;95(1):98-101. (http://www.hubmed.org/display.cgi?uids=15638904).

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