Background: Systemic absorption of topical phenylephrine administered during mydriasis may potentially cause hemodynamic changes in patients. Objective: To compare the hemodynamic outcomes between patients given tropicamide+phenylephrine and those given tropicamide alone for mydriasis. Design: Randomized controlled trial. Setting: Ophthalmology Outpatient Clinic, Southern Philippines Medical Center, Davao City, from April to June 2017. Participants: 56 male and female patients aged ≥ 19 years and scheduled for mydriasis. Interventions: Random allocation to either one drop of 0.5% tropicamide plus 0.5% phenylephrine or one drop of 0.5% tropicamide for mydriasis of the examined eye. Main outcome measures: Mean systolic BP, mean diastolic BP, mean arterial pressure, mean heart rate, and at least one episode of tachycardia or bradycardia. Main results: Thirty (53.57%) patients received tropicamide drops, and the rest received tropicamide+phenylephrine drops. The demographic and clinical characteristics of the two intervention groups were comparable at baseline. The mean blood pressures and heart rates at 15, 30, 45, and 60 minutes postmydriasis did not significantly differ between the two groups. Four patients from the tropicamide group, and none from the phenylephrine+tropicamide group had tachycardia (p=0.1153). On the other hand, five patients from the tropicamide group, and four from the phenylephrine+tropicamide group had bradycardia (p=1.0000). Conclusion Hemodynamic outcomes did not significantly differ up to 60 minutes after mydriasis between patients who received tropicamide+phenylephrine drops and those who received tropicamide drops.
Blood Pressure ; Heart Rate ; Sympathomimetics ; Muscarinic Antagonists ; Parasympatholytics

Overactive bladder is a chronic condition defined by bothersome urgency with or without urgency incontinence, usually associated with daytime frequency and nocturia. The treatment of this condition is to control bothersome urinary symptoms and is therefore to improve quality of life. The Korean Continence Society published the overactive bladder guideline in 2007, which suggested the mainstay of management is behavioral therapy and antimuscarinic pharmacotherapy. With growing awareness toward overactive bladder and quality of life, clinical information regarding antimuscarinic agents should be updated. There are several agents with good level of evidence and good grade of recommendation. Newer antimuscarinic agents are available or will be available in near future. The pharmacological properties, efficacy and tolerability of oxybutynin, trospium, propiverine, tolterodine, darifenacin, solifenacin, fesoterodine and imidafenacin are reviewed and discussed here. The results of major clinical studies are summarized.
Cholinergic Antagonists* ; Drug Therapy ; Muscarinic Antagonists ; Nocturia ; Quality of Life ; Urinary Bladder, Overactive* ; Solifenacin Succinate ; Tolterodine Tartrate

Overactive bladder(OAB) is a symptom syndrome including urinary urgency with or without urinary incontinence, usually with frequency and nocturia. Urgency, defined as the compelling feeling of impending incontinence that is difficult to defer, is the cornerstone symptom of OAB. The diagnosis is based on symptoms alone and assumes no underlying pathology. Approximately 12.2% of the adult population experience OAB in Korea. The syndrome is now recognized as a chronic debilitating condition that negatively affects the quality of life. Often the patients have a restricted social life and an increased risk for depression. Despite increased awareness in recent years, OAB remains an underreported condition. Continued evolution of our understanding of the pathophysiology of OAB has identified contributory mechanisms, which has in turn established structured evidence-based managements. Treatment of OAB is aimed at relief of symptoms and improving quality of life. Conservative treatments combined with antimuscarinic drugs are the main treatment for OAB. There are many antimuscarinics available, with several under development, which have different specificities for the muscarinic receptors. Other drugs have also been tried but with limited success. Behavioral therapy combined with pharmacological therapy often will bring about acceptable outcomes for patients with OAB. Modalities such as botulinum toxin injections, neuromodulation, and various surgical interventions also are showing encouraging results in more refractory patients. Further research into the basic science of the condition is required to identify the true cause of OAB, allowing new targeted treatments to be established.
Adult ; Botulinum Toxins ; Depression ; Diagnosis ; Humans ; Korea ; Muscarinic Antagonists ; Nocturia ; Pathology ; Quality of Life ; Receptors, Muscarinic ; Urinary Bladder, Overactive* ; Urinary Incontinence

Stimulation of muscarinic receptors by carbachol (CCh) in the circular smooth muscle of the guinea pig gastric antrum causes muscle contraction. In the present study, muscarinic receptor subtype controlling the muscle contraction in response to CCh was studied using putative muscarinic receptor antagonists. Isometric force of the isolated circular muscle strips was measured in an organ bath. CCh contracted the muscle in a dose-dependent way, and each of the three muscarinic receptor antagonists, 4-diphenylacetoxy-N-methylpeperdine methiodide (4-DAMP), methoctramine and pirenzepine shifted the concentration-response curves to the right without significantly reducing the maximum force. The affinities of the muscarinic antagonists (pA2 values) obtained from Schild plot analysis were 10.15, 7.05 and 6.84 for 4-DAMP, methoctramine and pirenzepine, respectively. These results suggest that the M3-subtype mainly mediate the muscle contraction in response to CCh in guinea pig gastric antrum.
Animals ; Baths ; Carbachol ; Guinea Pigs* ; Guinea* ; Muscarinic Antagonists ; Muscle Contraction* ; Muscle, Smooth ; Pirenzepine ; Pyloric Antrum* ; Receptors, Muscarinic*

PURPOSE: To determine the baseline clinical characteristics associated with dose escalation of solifenacin in patients with overactive bladder (OAB). METHODS: We analyzed the data of patients with OAB (micturition frequency > or =8/day and urgency > or =1/day) who were treated with solifenacin and followed up for 24 weeks. According to our department protocol, all the patients kept voiding diaries, and OAB symptom scores (OABSS) were monitored at baseline and after 4, 12, and 24 weeks of solifenacin treatment. RESULTS: In total, 68 patients (mean age, 60.8+/-10.0 years) were recruited. The dose escalation rate by the end of the study was 41.2%, from 23.5% at 4 weeks and 17.6% at 12 weeks. At baseline, the dose escalator group had significantly more OAB wet patients (53.6% vs. 20.0%) and higher total OABSS (10.2+/-2.4 vs. 7.9+/-3.5, P=0.032) than the nonescalator group. OAB wet (odds ratio [OR], 4.615; 95% confidence interval [CI], 1.578-13.499; P<0.05) and total OABSS (OR, 1.398; 95% CI, 1.046-1.869; P<0.05) were found to be independently associated with dose escalation. CONCLUSIONS: Patients who have urgency urinary incontinence and high total OABSS have a tendency for dose escalation of solifenacin.
Elevators and Escalators ; Humans ; Muscarinic Antagonists ; Solifenacin Succinate ; Urinary Bladder, Overactive* ; Urinary Incontinence

PURPOSE: To prospectively investigated the symptom changes in women with an overactive bladder (OAB) after discontinuation of 3 months of successful treatment with antimuscarinics and the pre-treatment factors that contributed to retreatment. MATERIALS AND METHODS: Sixty-eight women (mean age 51.4 years) with improvement in the symptoms of OAB after 4 weeks of treatment with propiverine hydrochloride (20mg/day) were prospectively enrolled in a protocol consisting of 8 further weeks of medication and a 4-week period of discontinuation. The frequency-volume charts were assessed before treatment, after the 12 weeks of therapy, and 4 weeks the end of the therapy. Changes in the frequencies, nocturia, urgency scores and urge incontinence at 12 and 16 weeks were evaluated. RESULTS: All of the OAB symptoms 4 weeks after discontinuation of medication remained improved compared to those initially recorded, but then deteriorated during further medication. At the baseline, and 12 and 16 weeks, the mean frequencies, nocturia and urgency scores per day were 11.2, 7.3 and 8.3, 1.6, 0.4 and 0.8, and 1.7, 0.6 and 1.2, respectively. The retreatment rate was 35.3%. Patients in the retreatment group were older (58.8 vs. 47.3 years, p<0.001) and had higher initial urgency scores (1.9 vs. 1.6, p=0.034). In an urodynamic study of 23 patients, those without detrusor overactivity (DO) maintained a significantly improved frequency after cessation of mediation, whereas those with DO (60.9%) did not. The retreatment rate was higher in patients with DO, but the difference was not significant. CONCLUSIONS: Three months of antimuscarinic therapy for OAB may not be sufficient. Older patients, or those with severe urgency, may be more likely to return to treatment.
Female ; Humans ; Muscarinic Antagonists ; Negotiating ; Nocturia ; Prospective Studies* ; Retreatment ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics

Bronchodilators are the cornerstone of symptomatic chronic obstructive pulmonary disease (COPD) treatment. They are routinely recommended for symptom reduction, with a preference of long-acting over short-acting drugs. Bronchodilators are classified into two classes based on distinct modes of action, i.e., long-acting antimuscarinics (LAMA, once-daily and twice-daily), and long-acting β2-agonists (LABA, once-daily and twice-daily). In contrast to asthma management, evidence supports the efficacy of both classes of long-acting bronchodilators as monotherapy in preventing COPD exacerbations, with greater efficacy of LAMA drugs versus LABAs. Several novel LAMA/LABA fixed dose combination inhalers are currently approved for COPD maintenance treatment. These agents show superior symptom control to monotherapies, and some of these combinations have also demonstrated superior efficacy in exacerbation prevention versus monotherapies, or combinations of inhaled corticosteroids plus LABA. This review summarizes the current data on clinical effectiveness of bronchodilators alone or in combination to prevent exacerbations of COPD.
Adrenal Cortex Hormones ; Asthma ; Bronchodilator Agents* ; Muscarinic Antagonists ; Nebulizers and Vaporizers ; Pulmonary Disease, Chronic Obstructive* ; Treatment Outcome

PURPOSE: The aim of this study was to investigate the efficacy and adverse effects of oral tolterodine compared to oxybutynin in children with a neurogenic bladder. MATERIALS AND METHODS: 16 patients, with persistent daytime or nighttime wetting after oxybutynin medication for the treatment of a neurogenic bladder, were enrolled. All 16 patients had been crossed-over from oxybutynin to tolterodine due to serious side effects or lack of improvement. The mean age was 6.4 years (range 3 to 11), and the mean body weight was 22kg (range 16 to 33). All patients were initially treated with oral tolterodine, 2mg, twice daily. The efficacy of tolterodine was assessed in comparison to oxybutynin, and considered as improved with a greater than 50% reduction in wetting episodes, as stationary with a less than 50% reduction or as increased or aggravated with a greater than 50% increase. The tolerability was also assessed using a questionnaire for adverse events. RESULTS: The mean duration of tolterodine treatment was 193 days (range 14 to 940). After treatment with an initial tolterodine dose of 2mg bid, 5 patients (31%) were improved, 8 (50%) were stationary and 3 (19%) were aggravated. Overall, the initial tolterodine dose showed equal efficacy to that of oxybutynin (p=0.483). Of the 16 patients, side effects developed in 12 (75%) during the oxybutynin treatment, whereas only 2 (13%) developed side effects during the tolterodine treatment (p=0.001). CONCLUSIONS: Compared to oxybutynin, tolterodine was well tolerated in children, allowing greater compliance and offering an equally effective treatment for neurogenic incontinence in children with a neurogenic bladder. Therefore, it seems that tolterodine can be safely and effectively used to replace oxybutynin in children with a neurogenic bladder.
Body Weight ; Child* ; Compliance ; Humans ; Muscarinic Antagonists ; Surveys and Questionnaires ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Tolterodine Tartrate

Despite a range of efficacious therapies for asthma, including inhaled corticosteroids (ICS) and long-acting β₂-agonists (LABA), a significant proportion of patients have poor asthma control and retain a risk of future worsening of their symptoms. Long-acting muscarinic antagonist (LAMA) bronchodilators offer a well-tolerated, efficacious, and cost-effective add-on to a patient's treatment. Of the LAMAs currently under investigation or available for the treatment of asthma, evidence from a comprehensive clinical trial program in adults and children shows that once-daily treatment with tiotropium provides benefits for patients with uncontrolled asthma despite the use of ICS and LABAs. Tiotropium is included in the Global Initiative for Asthma (GINA) strategy document as an add-on therapy option for patients at Step 4 or 5 with a history of asthma exacerbations. Tiotropium Respimat® has demonstrated safety and efficacy in patients with a range of disease severities, ages, and phenotypes. This review describes the evidence for the use of LAMA as add-on therapy for patients with asthma who remain uncontrolled despite the use of ICS and LABA treatments.
Adrenal Cortex Hormones ; Adult ; Asthma* ; Bronchodilator Agents ; Child ; Humans ; Muscarinic Antagonists* ; Phenotype ; Tiotropium Bromide

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled beta2 agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.
Adrenal Cortex Hormones ; Cholinergic Antagonists ; Comorbidity ; Glycopyrrolate ; Humans ; Muscarinic Antagonists ; Polypharmacy ; Pulmonary Disease, Chronic Obstructive ; Scopolamine Derivatives ; Tiotropium Bromide