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OAB tablets and patient safety

#Overactivebladder syndrome, (OAB), describing #urinaryurgency of unknown cause, was so named because #urodynamic investigations of complainants revealed #bladdercontractions at volumes below expected norms.


#Detrusor overactivity was blamed. For about a decade, tricyclic #antidepressant tablets, having antimuscarinic properties, were unofficially repurposed to antagonise detrusor receptors before being overtaken by oxybutynin’s approval by the FDA in 1976. It spawned a #multibillion-dollar market with a plethora of “me-too” tablets and captured in the net neuropaths with urgency and disinhibited detrusors, e.g people with #multiple #sclerosis (#MS).


The simplest thought analysis at the time would have raised doubts about the science, because contractions/relaxations do not correlate with continuous urgency sensations, whereas progressive bladder distension does.


Some years ago, uro-neurophysiologists and latterly pharmacologists debunked the dogma. Detrusor contractions merely are epiphenomena. Far more likely the source of such urgency lies somewhere in the sensory arc of the micturition neural circuitry, starting in bladder urothelium and ascending to the brain, with detrusor simply responding to abnormal instructions from the urothelium or brain in the only way it can.


Many years later, still without a shred of evidence that #overactivity is causative, the label OAB remains and such prescribed treatments float through patients’ systems producing side effects, while barely influencing urgency, but they endure while new ones entered the markets and are sold to suffering patients at taxpayer expense, while driving some patients into nursing care because of treatment failures, drug-induced #cognitive #impairments or other of the ubiquitous adverse side effects such systemic drugs readily produce, all with official approval.


What do patient safety regulators think about that?


What’s the value proposition to the NHS or Medicare?


I propose patient safety regulators and clinical governance stewards update drug review mechanisms.


Patients and prescribers need safe, #trustworthy #treatments.

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