Clinical Review

Lesson of the week: Oxybutynin and cognitive dysfunction

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7119.1363 (Published 22 November 1997) Cite this as: BMJ 1997;315:1363
  1. C A Donnellan, senior registrara,
  2. L Fook, registrara,
  3. P McDonald, senior registrara,
  4. J R Playfer, consultant physiciana
  1. a Department of Geriatric Medicine, Royal Liverpool University Hospital, Liverpool L7 8XP
  1. Correspondence to: Dr Donnellan
  • Accepted 20 May 1997

Introduction

Anticholinergic drugs have been used since the 19th century, when belladonna alkaloids were first given for treatment of Parkinson's disease. Their use declined because they were poorly tolerated, particularly by elderly patients. Recently, anticholinergic drugs have started to be used again for treating detrusor instability and hyperreflexia. Oxybutynin is an antimuscarinic used for this purpose, and its efficacy and adverse effects have been described.1 2 We report four cases of cognitive dysfunction in association with oxybutynin treatment.

Case reports

Case 1—A 79 year old man with Parkinson's disease, chronic obstructive pulmonary disease, peptic ulcer disease, and irritable bladder was seen regularly in the clinic for Parkinson's disease at this hospital. He was taking selegiline, co-beneldopa, ranitidine, theophylline, intermittent courses of prednisolone, and inhaled beclomethasone dipropionate and salbutamol. In May 1994 he developed mild cognitive impairment. Selegiline was discontinued; this resulted in a noticeable improvement. His score in the abbreviated mental test was 9/10. Later that year he started taking oxybutynin (2.5 mg three times a day) for his urinary symptoms. …

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