Which antimuscarinic agents used in the treatment of overactive bladder increase heart rate? a prospective randomized clinical trial

  • Bulent CetinelEmail author
  • Bulent Onal
  • Mehmet Hamza Gultekin
  • Muhammed Guzelsoy
  • Fethi Ahmet Turegun
  • Murat Dincer
Urology - Original Paper



To compare the heart rate increase side effect of different antimuscarinic drugs used in overactive bladder (OAB).


Overall 341 patients were consecutively randomized to take seven different antimuscarinic drugs between January 2014 and June 2016 at three institutions, and 250 patients who completed the follow-up visits were accepted into this study. Ninety-one patients who never came to visits were excluded. Drugs were classified into two groups as selective (darifenacin hydrobromide, solifenacin succinate and oxybutynin hydrochloride) and non-selective (fesoterodine fumarate, tolterodine tartrate, trospium chloride and propiverine hydrochloride) antimuscarinic drugs. The cardiac pulse rates and the blood pressures were recorded during the baseline, first visit (1 week) and second visit (1 month). Data were compared for drugs and two groups (selective versus non-selective) by using ANOVA test.


Baseline characteristics were similar among the patients using different antimuscarinic drugs. Statistically significant increase in heart rate occurred in patients treated with non-selective antimuscarinic drugs compared to those treated with selective drugs (p < 0.001), and this increase was especially evident in patients treated with trospium chloride, tolterodine tartrate, fesoterodine fumarate and propiverine hydrochloride (p < 0.001, 0.003, 0.011 and 0.37, respectively). There was no statistical difference for the other side effects.


Our results showed that heart rate significantly increased in OAB patients treated with non-selective antimuscarinic drugs. Trospium chloride, tolterodine tartrate, fesoterodine fumarate and propiverine hydrochloride seem to have the most unfavorable properties with regard to increased heart rate side effect when compared to the other antimuscarinic drugs (darifenacin hydrobromide, solifenacin succinate and oxybutynin hydrochloride).


Antimuscarinics Cardiovascular system side effects Muscarinic receptor selectivity Overactive bladder 


Authors’ contribution

BC contributed to protocol/project development, manuscript writing/editing. BO, MHG helped with protocol/project development, data collection or management, data analysis, manuscript writing/editing. MG, FAT, MD involved in data collection or management.

Compliance with ethical standards

Conflict of interest

Authors of this study have no conflict of interest.

Ethical approval

This open-label, prospective, multi-center, randomized and controlled follow-up study has institutional approval from Cerrahpasa School of Medicine Ethical Commitee with IRB number of 671/2014.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Bulent Cetinel
    • 1
    Email author
  • Bulent Onal
    • 1
  • Mehmet Hamza Gultekin
    • 1
  • Muhammed Guzelsoy
    • 2
  • Fethi Ahmet Turegun
    • 1
  • Murat Dincer
    • 3
  1. 1.Department of Urology, Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey
  2. 2.Department of UrologyBursa Yuksek Ihtisas Education and Research Hospital, University of Health SciencesBursaTurkey
  3. 3.Department of UrologyBagcilar Training and Research Hospital, University of Health SciencesIstanbulTurkey

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