Effects on sleep of anticholinergics used for overactive bladder treatment in healthy volunteers aged > or = 50 years.

OBJECTIVE: To study the influence of oxybutynin, tolterodine or trospium chloride, anticholinergics used to treat bladder overactivity, on sleep and the cognitive skills of healthy volunteers aged > or = 50 years. SUBJECTS AND METHODS: In a randomized, double-blind, placebo-controlled study with a crossover design, 24 healthy sleepers (12 men and 12 women) aged 51-65 years underwent polysomnographic recordings and cognitive tests in a sleep laboratory. Study medications were given as a single dose containing the total recommended daily dose. RESULTS: There was a significant reduction in rapid-eye movement (REM) sleep of approximately 15% and a slightly (but not significantly) greater REM latency after oxybutynin and tolterodine than with placebo. After trospium chloride, REM duration and latency were comparable with placebo. There was no effect of the tested anticholinergics on cognitive and subjective sleep variables. CONCLUSION: Individuals aged > or = 50 years had a more distinct impairment of REM sleep after oxybutynin and tolterodine than had young people, but the reduction in REM sleep did not reach a pathological degree in this single-dose study. There was no apparent impairment of concentration or cognitive function, but impairment of cognitive function and neuropsychological side-effects cannot be excluded, especially when elderly patients with impaired REM sleep from various psychiatric diseases (e.g. depression) and/or sleep disturbances are given oxybutynin or tolterodine in long-term treatment.

Randomised, double-blind study of the effects of oxybutynin, tolterodine, trospium chloride and placebo on sleep in healthy young volunteers.

OBJECTIVE: Central nervous effects of oral anticholinergics may limit the success of incontinence therapy and patient compliance. Only a few studies investigating this topic are available. This study was conducted to determine whether oral anticholinergics alter sleep and psychometric test parameters. DESIGN: Randomised, double-blind, crossover, placebo-controlled study. STUDY PARTICIPANTS: 24 healthy volunteers (age 22-36 years) without sleeprelated problems. INTERVENTIONS: Polysomnographic recordings, sleep questionnaires and psychometric tests (the number combination test [Zahlen-Verbindungs Test; ZVT] and the d2 attention test) were performed following single doses of oxybutynin 15mg, tolterodine 4mg, trospium chloride 45mg or placebo, each separated by an 8-day washout period. RESULTS: Rapid eye movement (REM) sleep (relative to total sleep time) was the primary parameter of polysomnography. The REM sleep for oxybutynin was significantly lower than that for trospium chloride (18.4% vs 20.2%; p < 0.05) and lower than that for placebo (20.1%; ns). The number combination test (ZVT), the primary parameter of cognitive function, and the d2 test did not reveal any differences in reaction time. With regard to the other sleep parameters, the REM latency for oxybutynin was clearly higher than that for placebo, trospium chloride and tolterodine. Effects on non-REM sleep were observed only after administration of oxybutynin compared with placebo. CONCLUSIONS: Oxybutynin influenced sleep structure, as was reflected by REM suppression and mild sedation, while subjective parameters and psychometric tests remained unaffected. The sleep and psychometric test values for tolterodine and trospium chloride were comparable to those of placebo. The clinical relevance of these effects is small in healthy young volunteers, but these results cannot be extended to the elderly.

Acetylsalicylic acid tablets with glycine improve long-term tolerability in antiplatelet drug therapy: results of a noninterventional trial.

To determine the tolerability of a glycine (Gly)-containing acetylsalicylic acid (ASA) preparation (Gly-ASA), investigators selected 1135 patients already receiving longterm antiplatelet therapy for a noninterventional trial of Gly-ASA 50 to 300 mg daily. After an average treatment period of 42.6 days, tolerability rating scores and the frequency of 5 gastrointestinal (GI) complaints were compared with those reported for any previous treatment, including plain ASA. After treatment with Gly-ASA, the mean percentage of patients without GI complaints increased more than 2-fold, from 28.2% to 60.6%. Furthermore, the mean percentage of patients reporting any GI symptoms as "always" present decreased from 8.5% to 0.5%. Gly-ASA tolerability was rated "excellent" or "good" by 98% of the patients. In 10 patients (0.9%), Gly-ASA treatment was terminated prematurely due to GI intolerance (n=4) and nonmedication-related causes (n=6). With respect to long-term treatment compliance, the improved tolerability profile observed with this Gly-ASA preparation indicates an important advantage over nonglycine-containing ASA alternatives.