There are many circumstances in one’s life when the bladder will become irritated and the patient will develop burning on urination or urgency, and urgency control problems frequently associated with frequency and nocturia (getting up frequently at night to urinate).
Acute bladder infections, stones in the bladder or lower ureteral, or issues after procedures such as cystoscopy, placement of ureteral stents and other prostate and bladder procedures, will cause the above symptoms. In the past, pain medications, for example, azo dye compounds (such as Pyridium) and low-dose barbiturates have been the treatment of choice and, more recently, the addition of antimuscarinics.
The newest antimuscarinic available is Sanctura XR 60 mg. It has M2 and M3 inhibition similar to other nonspecific antimuscarinics. However, this new once-a-day dosage has great advantages in those patients who have an acute bladder problem and need relief from the irritative symptoms.
This is the only antimuscarinic that is basically excreted in the urine as the active substance. Within two hours, there are adequate levels of Sanctura XR in the bladder to have an effect on the sensory M2 components of the bladder. All of the other antimuscarinics work systemically, through the blood stream, and take anywhere from 1-6 weeks to be effective.
Another advantage is that since the drug is not metabolized in the liver and does not affect a liver enzyme system, other medications that patients may take that do involve liver metabolism as not interfered with by using this urine-secreted drug. In general, there are no drug-drug interactions between Sanctura and any other drug that a patient may take, relieving the concerns of the patient and the physician.
The direct inhibition of the suburethral M2 receptors increases the sensory threshold of the bladder and allows more urine to give less sensation of fullness. In addition, within days the systemic effect probably begins by inhibiting the muscular M3 receptors, allowing the bladder to hold more urine during the filling phase. (May, 2008)
(Disclosure: Dr. Murdock has been a Principal Investigator for Allergan, makers of Sanctura)
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