Cardiac effects of muscarinic receptor antagonists used for voiding dysfunction

Authors

  • Karl-Erik Andersson,

    Corresponding author
    1. Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine Winston Salem, NC
      Professor Karl-Erik Andersson MD, PhD, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.
      Tel.: + 1 336 713 1195
      Fax: + 1 336 713 7290
      E-mail: karl-erik.andersson@med.lu.se
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  • Lysanne Campeau,

    1. Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine Winston Salem, NC
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  • Brian Olshansky

    1. Cardiac Electrophysiology, University of Iowa Hospitals, Iowa City, Iowa, USA
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Professor Karl-Erik Andersson MD, PhD, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.
Tel.: + 1 336 713 1195
Fax: + 1 336 713 7290
E-mail: karl-erik.andersson@med.lu.se

Abstract

Antimuscarinic agents are the main drugs used to treat patients with the overactive bladder (OAB) syndrome, defined as urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia. Since the treatment is not curative and since OAB is a chronic disease, treatment may be life-long. Antimuscarinics are generally considered to be ‘safe’ drugs, but among the more serious concerns related to their use is the risk of cardiac adverse effects, particularly increases in heart rate (HR) and QT prolongation and induction of polymorphic ventricular tachycardia (torsade de pointes). An elevated resting HR has been linked to overall increased morbidity and mortality, particularly in patients with cardiovascular diseases. QT prolongation and its consequences are not related to blockade of muscarinic receptors, but rather linked to inhibition of the hERG potassium channel in the heart. However, experience with terodiline, an antimuscarinic drug causing torsade de pointes in patients, has placed the whole drug class under scrutiny. The potential of the different antimuscarinic agents to increase HR and/or prolong the QT time has not been extensively explored for all agents in clinical use. Differences between drugs cannot be excluded, but risk assessments based on available evidence are not possible.

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