A hyperactive bladder, also called an overactive bladder, is a bladder control condition that involves sudden and intense urinary urge often with leakage of urine, known as urge incontinence. The Consumer Reports Health guide on the "Best Buy Drugs for Overactive Bladder" reports that 15 to 20 million Americans have a hyperactive bladder. Anticholinergic medications block the action of acetylcholine, a chemical that triggers the muscle in the bladder wall to contract, which relieves the symptoms of sudden urge to urinate, urine leakage and frequent urination. Although each of these medications is an anticholinergic, they differ in how they are administered, their side effects and their costs.
Oxybutynin
Oxybutynin, approved by the Food and Drug Administration (FDA) for use since 1976, is the oldest medication marketed for hyperactive bladder. There are several forms of this medication: a short-acting pill that requires two to three pills a day, a long-release pill that can be taken just once a day and a patch that is adhered to the skin.
Short-acting oxybutynin is the most well known and well studied of all the overactive bladder medications, according to the Consumer Reports. Another advantage is that there is a generic equivalent which makes this medication affordable. The downfall of short-acting oxybutynin is that there is a high rate of side effects, including dry mouth and constipation.
Extended release oxybutynin was created from the original oxybutynin but has the advantage of being taken only once a day. The disadvantage remains the high frequency of side effects and this form of the medication costs more than the short-acting formulation.
The oxybutynin patch only needs to be changed every 2 to 3 days and eliminates the need for any pills, however it is less effective than the pill formulations. In addition, the frequency of side effects is lower than for the other two medications although some do experience skin irritation at the site of the patch.
Tolterodine
Tolterodine, approved for use in 1998, is also available as a short-acting or extended release medication. The short-acting formulation has shown to have fewer side effects than oxybutynin, according to the Consumer Reports, but the effectiveness as compared to oxybutynin is not known. The extended-release tolterodine has fewer side effects than both the oxybutynin and the short-acting tolterodine, but it is more expensive than either medication.
Trospium
There is less research on the effectiveness and side effects of trospium, which was approved for use in 2004, but it has shown to be less likely to cause constipation than the previously mentioned medications. Trospium is available as both a short-acting tablet and an extended-release capsule.
Solifenacin and Darifenacin
Solifenacin and darifenacin, both approved in 2004, are available as an extended-release tablet that only needs to be taken once a day. As with the other extended-release formulations, these medications are more expensive than the rapid-acting formulations and much more expensive than the available generic.
