Propiverine Hydrochloride vs Previous Anticholinergic Agents

- Dr. Jonathan D’Souza PhD (A.M.), MSc. MBA

What is an Overactive Bladder?

Overactive bladder (also known as Overactive Bladder Syndrome) is a urological condition related to problems with urination. [1]

1. Abrams, P; Cardozo, L; Fall, M; Griffiths, D; Rosier, P; Ulmsten, U; Van Kerrebroeck, P; Victor, A; Wein, A; Standardisation Sub-Committee of the International Continence, Society (January 2003). "The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.". Urology 61 (1): 37–49. PMID 12559262

Causes of Overactive Bladder

Causes of overactive bladder: [1]

Age

Diabetes

Certain Medications (diuretics)

Lifestyle Choices

Excessive consumption of Caffeine or

Alcohol

1. "DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER (Non-Neurogenic) IN ADULTS: AUA/SUFU GUIDELINE". American Urological Association. Retrieved 25 Aug 2013

Signs and Symptoms of Overactive Bladder

Sudden urge to urinate that's difficult to control.

Urge incontinence - the involuntary loss of urine immediately

following an urgent need to urinate.

Urinate frequently, usually 8 or more times in 24 hours.

Awaken 2 or more times in the night to urinate (nocturia).

Drugs with anticholinergic activity are the first-line drugs to treat OAB symptoms.

Drugs used:• Solifenacin• Tolterodine• Imidafenacin• Propiverine Hydrochloride

First Line of Treatment

Effectiveness of Propiverine Hydrochloride

DUAL ACTION:

1. Anticholinergic activity

+

2. Calcium antagonist activity (not seen in other anticholinergic agents such as solifenacin, tolterodine and imidafenacin)

A. Haruno, Y. Yamasaki, K. Miyoshi et al., “Effects of propiverine and its metabolites on isolated guinea pig urinary bladder,” Folia Pharmacol Japan, vol. 94, pp. 145–150, 1989

What Is An Anticholinergic Agent?An anticholinergic agent is a

substance that inhibits the parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Anticholinergics help treat overactive bladder by affecting the nerve function of the bladder muscle (detrusor) to relax.

Helps reduce urinary urgency.

Calcium- channel blocker

Calcium – channel blockers inhibit bladder contraction by decreasing calcium available for smooth-muscle contraction.

Propiverine Hydrochloride vs Oxybutynin Hydrochloride

A double blind randomized control study demonstrated that propiverine was superior to oxybutynin hydrochloride in terms of improvement of pollakisuria and urinary incontinence associated with neurogenic bladder and unstable bladder. [1]

1. M. Stohrer, G. Murtz, G. Kramer, F. Schnabel, E. P. Arnold, and J. J. Wyndaele, “Propiverine compared to oxybutynin in neurogenic detrusor overactivity: results of a randomized, double-blind, multicenter clinical study,” European Urology, vol. 51, no. 1, pp. 235–242, 2007.

Clinical trial to compare effectiveness of Propiverine Hydrochloride

Naoya Masumori, Shintaro Miyamoto, Taiji Tsukamoto, et al., “The Efficacy and Safety of Propiverine Hydrochloride in Patients with Overactive Bladder Symptoms Who Poorly Responded to Previous Anticholinergic Agents,” Advances in Urology, vol. 2011, Article ID 714978, 4 pages, 2011. doi:10.1155/2011/714978

Summary of the Clinical Study29 men and 44 women. A total of 73 patients participated in the clinical study.

Median age of the 73 patients was 71 years.

Out of 73 patients, 52 patients completed the study.

Among subjects who completed the study, OAB symptoms of nighttime frequency, urgency, and urgency incontinence (except daytime frequency) showed significant improvement with propiverine treatment.

Propiverine vs previous anticholinergic agents

THANK YOU

By

Dr. Jonathan D’SouzaPhD (A.M.), MSc. MBA