Drug adherence poor in women with urinary trouble

The odds are high that a woman who is prescribed an "anticholinergic" drug to relieve urinary incontinence or other lower urinary tract symptom will discontinue the medication not long after starting it, a study suggests. This is true regardless of the class of medication used.

Two examples of anticholinergic drugs that are often prescribed for urinary incontinence are oxybutynin (Ditropan) and tolterodine (Detrol).

"Our high discontinuation rates across all anticholinergic drug classes...highlight the need for more effective therapies for lower urinary tract symptoms," Dr. Manish Gopal from Saint Peter's University Hospital, New Brunswick, New Jersey and colleagues conclude.

Using a large database, Gopal and colleagues analyzed 29,369 women aged 18 and older who were initially prescribed an anticholinergic medication, such as Ditropan or Detrol, between 1991 and 2005.

They found that half of women prescribed an anticholinergic stopped taking it by 6 months, and 3 out of 4 women discontinued therapy by 1 year. The median time to discontinuation for all 9 different anticholinergic drugs was about 4 months after initial use.

In a report in the journal Obstetrics and Gynecology, the investigators note that rates of discontinuation increased with duration of use, and "very few women" switched to another drug after initial prescribed treatment before stopping the drug.

Because of the high discontinuation rates of anticholinergic therapy for lower urinary tract symptoms, health care providers "must be vigilant" regarding alternative forms of treatment, such as bladder training and pelvic floor rehabilitation, for overactive bladder "and increase our awareness that this group of women is being treated inadequately," the investigators conclude.

SOURCE: Obstetrics and Gynecology, December 2008.