Kadýn ve Ýþlevsel Üroloji Bülteni
Ýþeme sonrasý idrar ölçülmelidir. Nörojen mesane ve iþeme disfonksiyonu ayýrt edilmelidir. Ýþeme günlüðü ile sývý alýmý ve idrar kaçýrmanýn olup olmadýðý gözden geçirilmelidir. Hastalarýn diðer hastalýklarýnýn varlýðý ve aldýklarý ilaçlar kontrol edilerek tedaviye baþlanmalýdýr. Özetle; karaciðer fonksiyonu önemliyse trospiyum ve fesoterodin, oksibutininin daha çok faydalý olduðu ancak aþýrý aðýz kuruluðu yaptýðý olgularda; oksibutinin bant veya jel formlarý, QT uzamasý ve kalp hýzý önemliyse darifenasin, bellek ve unutkanlýk önemliyse darifenasin ve trospiyum, tolterodinden memnun ancak daha etkili ajan isteniyorsa fesoterodin, kombine etki isteniyorsa propiverin, kullanýlan antikolinerjiklerin etkisiz olduðu durumlarda denenmeyen ajanlar kullanýlabilir.
SONUÇ Bütün farmakolojik tedavilerde olduðu gibi ilaca minimal dozda baþlanmalý, istenen etkiye ve yan etkilerine göre doz titrasyonu yapýlmalý veya diðer alternatif ilaçlara geçilmelidir. AAM yaþla birlikte artmakta, ayrýca yaþlýlarda özellikle hipertansiyon, DM, KV hastalýklar ve biliþsel bozukluklar da artmaktadýr. KC ve böbrek fonksiyonlarý da göz önünde bulundurulmalýdýr. Bununla birlikte özellikle yaþlýlýkta antikolinerjiklerle birlikte kullanýlmasý gereken ilaç sayýsýnda da artýþ meydana gelmektedir. Antimuskarinik kullanýmý gündeme geldiðinde tüm bu faktörler göz önüne alýnarak tedavi düzenlenmeli ve doz titrasyonu ayarlanmalýdýr.
REFERANSLAR 11. Appell RA, Abrams A, Drutz HP, Van Kerrebroeck PE, Millard R, et al. Treatment of overactive bladder: long-term tolerability and efficacy of tolterodine. World J Urol 19: 141-7, 2001 12. Kerrebroeck V, Kreder J, Jonas U, Zinner N, Wein A. Tolterodine once daily: superior efficacy and tolerability in the treatment of overactive bladder. Urology 57: 414-21, 2001 13. Michel MC. Fesoterodine: a novel muscarinic receptor antagonist for the treatment of overactive bladder syndrome. Expert Opin Pharmacother 9: 1787-96, 2008 14. Pfizer Inc.: Detrol LA tolterodine tartrate extended release capsules; 15. Wefer J, Truss MC, Jonas U. Tolterodine: an overview. World J Urol 19: 312-8, 2001 16. Rovner ES. Trospium chloride in the management of overactive bladder. Drugs 64: 2433-46, 2004 17. Skerjanec A. The clinical pharmacokinetics of darifenacin. Clin Pharmacokinet 45: 325-50, 2006 18. Simpson D, Wagstaff AJ. Solifenacin in overactive bladder syndrome. Drugs Aging 22: 10619, 2005 19. Herschorn S, Pommerville P, Stothers L, Egerdie B, Gajewski J, et al. Tolerability of solifenacin and oksibutinin immediate release in older (>65 years) and younger (<65 years) patients with overactive bladder: sub-analysis from a Canadian, randomized, double-blind study. J Curr Med Res Opin 27: 37582, 2011 20. Lam S, Hilas O. Pharmacologic management of overactive bladder. Clin Int Aging 2: 337-45, 2007 21. Beytur A, Yalçýnkaya FR. Aþýrý aktif mesane tedavisinde Farmakoterapi. Türk Üroloji Seminerleri 1: 32-36, 2010 22. Cole P. Fesoterodine, an advanced antimuscarinic for the treatment of overactive bladder: a safety update. Drugs Fut 29: 715-20, 2004
1. Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ and Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int 101: 1388-95, 2008 2. Foon R, Drake MJ. The overactive bladder. Therap Adv Urol 2(4): 147-55, 2010 3. Kato K, Furuhashi K, Suzuki K, Murase T, Sato E and Gotoh M. Overactive bladder and glaucoma: a survey at outpatient clinics in Japan. Int J Urol 14: 595-7, 2007 4. Abrams P, Kaplan S, De Koning Gans HJ and Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175: 999-1004, 2006 5. Cardozo L. The overactive bladder syndrome: treating patients on an individual basis. BJU Int 99 (Suppl 3): 17, 2007 6. Witte LP, Mulder WM, de la Rosette JJ, Michel MJ. Muscarinic receptor antagonists for overactive bladder treatment: does one fit all? Cur Opin Urol 19: 13-19, 2009 7. Zanger UM, Raimundo S, Eichelbaum M. Cytochrome P450 2D6: overview and update on pharmacology, genetics, biochemistry. Naunyn Schmiedebergs Arch Pharmacol 369: 23-37, 2004 8. Schröder A, Abrams P, Andersson KE, Artibani W, Chapple CR, et al. Guidelines on Urinary incontinence. European Associtation of Urology, 2010 9. Lai HH, Boone T, Appell RA. Selecting a medical therapy foroveractive bladder. Rev Urol 4: 28-37, 2002 10. Michel MC, Hegde SS. Treatment of the overactive bladder syndrome with muscarinic receptor antagonists: a matter of metabolites? Naunyn Schmiedebergs Arch Pharmacol 374: 79-85, 2006
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