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    Overactive Bladder: When You Have to Go, Go, Go


    Results of the trial indicate that the Ditropan XL was as just good as Detrol in terms of side effects but significantly better in resolving symptoms, according to a report that appears in the April edition of Mayo Clinic Proceedings.

    "There are now two very fine medications that can help patients who have significant problems with overactive bladder, urinary frequency and urgency, and urge incontinence -- in which patients are not able to get to the bathroom in time," says Rodney A. Appell, MD, author of the report. "Ditropan was shown to be more effective than the Detrol and had an equal ability to reduce the side effects usually associated with medication."

    The study was funded by Alza Corporation, of Mountain View, Calif., which manufactures Ditropan. Appell is head of the corporation's scientific advisory board. He is also the F. Brantley Scott Professor of Urology at Baylor College of Medicine in Houston.

    Ditropan XL is a new version of a drug long used for overactive bladder -- but the older version was associated with significant side effects, including dry mouth and blurred vision. As Appell explains, enzymes in the stomach and the small intestine break down the active agent in the older form of Ditropan into a metabolite, which gets into the bloodstream and causes the side effects.

    But the new drug employs an ingenious system to bypass the stomach and small intestine and deliver the drug to the large intestine, which is free of the enzymes. "It's a capsule with a tiny hole in it," Appell says. "As it goes through the intestinal system it sucks in water, which pushes out the medication. That delays the delivery of the drug until it gets into the large intestine."

    The drug appears to act by inhibiting release of acetylcholine, a chemical in the central nervous system that causes the bladder to contract. "In patients with an overactive bladder, the main problem is over-stimulation of the bladder muscle and the nerves going to the bladder," says Elliott, who wrote an editorial accompanying the report. "The medications are designed to blunt or lower the response of those muscles and help the bladder relax."

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