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Hi everyone, Well I started Oxybutinin yesterday (5mg/day). I didn't really get any side effects yet like many here have mentioned. I read the cautions on the prescription paper and was surprised at all the possible problems. I got me thinking about interactions and such so I did some web searching.

What I stumbled on has me a little concerned. Last June a paper was published in JAMA ( a prestigious medical journal) about the possible long term effects of anticholinergics, which Oxybutinin is one. It seems there is a link between long term anticholinergics use and dementia/alzhiemers. The official paper is pretty much jibberish to me as much of it is definitions of the statistical technique and terms that are in medical profession language. So I did quite a bit more digging to find the results in plain English.

It seems that taking a 3.9 mg dose (smallest dose marketed is 5mg) for more than five years is enough to raise the risk of dementia/alzhiemers from 11% for general population to 23.2%. This is for people 65 and older (I'm 62). That's an increase of over 100% in the risk factor. EEK!
Anticholinergics are also used in over the counter in drugs like Benedryl. So practically everyone is in contact with this stuff. If I've read it right the effects are cumulative. Meaning it's the total amount of the drug that you take. Not how long you take it.

I printed off a copy of a site to send to my doctor for him to see. If I hear anything back from him I'll post it. I'm taking this all with a grain of salt though as the site I copied, Cogentixmedical.com is a company that markets electrical stimulation devises for bladder control. They have a vested interest in the failure of any drug that competes against them. If anyone has something to add or knows something about this study, Please post.

Anyways hope you all have a happy and prosperous New Year, Ted

Wow!!

--John

I think I will stick with my diapers. hehe

If you post a link to the JAMA article I'll read it for you to confirm.

I used to teach bio stats, human physiology, and medical terminology; so I'm pretty accustomed to reading medical literature for content.

I took a few of them and never had good luck. I decided to stick with diapers and Foley catheters.......

Years ago I took Oxybutinin; it was a disaster. It gave me overwhelming dry mouth, so I began to drink more, thinking that I was thirsty. At the time, before any of my bladder surgeries, my bladder was spasming painfully every hour or more. The excess water I drank made this worse.

I think the greatest statistical risk for getting dementia is getting older.

Thanks for keeping an eye on this.

Hey MSUspartan, You can find the abstract at ncbi.nlm.nih.gov/pubmed/25621434

It appears to me that the more you take the greater the risk. It's starting to make other options look better to me that's for sure. Ted

Reading only the abstract (I might be able to pull the full article next week), I have a couple comments.

First, this was a type 2 model (the researchers are only recording data, not performing an experimental manipulation) analysis. Most medical studies are of this type, for ethical reasons, and suffer from inability to draw inferential conclusions about strong causation. Essentially, they can never be certain that the effect observed isn't an artifact of the group, because they aren't randomizing the group, and they aren't controlling the treatment. In this case, it's possible that it's not the anticholinergic causing the dementia, but the group that is otherwise predisposed for dementia is also self selecting for anticholinergic use, or that the underlying disorder being treated with the anticholinergics is responsible for the dementia rather than the drugs themselves.

Second, using a Cox proportional hazard model where you disregard the treatment in the last segment, and continuously replace censored data points is certainly not standard, and gives me pause, but might be explained better in the full article, and I would suspect would make their estimates more conservative, so that's probably OK.

Those caveats aside, it seems reasonable to conclude there is a link between anticholenergic use and dementia/Alzheimer's disease. I don't see evidence that the effect is necessarily cumulative, but there is definitely a dose-response relationship. Interestingly, at the lowest dose level, the use of anticholenergics decreased the the prevalence of dementia vs. normal population. This could be a hormetic effect, or just an anomaly; it's hard to say.

Hello MSU, Thank you for the quick response. Like most things, it seems there's not too many clear cut answers. Like I said in my first post I was suspect of the site I got the simple data from. I find it hard to trust most corporations at being truly honest. There's usually a hidden motive for everything they put out there. Especially when they would profit from the elimination of these OAB drugs.

You obviously know a TON more about these types of studies than I do (I know like uh.... nothing). So what's your gut feeling? Note that I say "gut". I understand that you probably aren't in a position to make a professional response. I realize these studies need to be taken with a grain of salt. With my age being in the "sweet spot" to end up on the losing end of this study in just a few years I'd like to hear your take if it were you at the age of 62. Thanks again MSU for your quick response. Ted

My gut reaction is that there is probably something to this, but it needs more study. Preferably they should separate out the different types of anticolenergics (OAB drugs, antihistamines, antidepressants, etc), and test them independently (or even repartition the existing data in that way, and show the results of those separate analyses). It would also be helpful to split the data based on disorder being treated. I would suspect that there might be a relationship between people being treated for depression, and dementia, that exists independent of the use of tricyclics. I would also suspect that the lowest dose group was most likely to be people taking antihistamines to treat allergies (hence they aren't taking a daily regime of medication for 10 years), and perhaps the antihistamines aren't having the same effect (remember, the lowest dose group actually had lower incidence of dementia than the control).

I'm also not sure that the issue at hand is cumulative consumption, so much as the possibility of a chronic effect from frequent use. If you were going on oxybutine for OAB, that would still out you in the frequent use category, so that doesn't necessarily apply for you, and would still out you in the wheelhouse of what this study was designed to detect.

In any case, I say the study is interesting, but the conclusions are probably premature. The problem is, the time it takes to reproduce a 10 year study means that, if they're right about anticholinergics, you might have dementia by the time anyone confirms these findings. If it were me, I'd be pretty cautious. There would be a long talk with my doctor coming.