What is the recommendation for the use of anticholinergics to treat lower urinary tract symptoms (LUTS) in patients aged 70-90 years?—GRACIELA WEST, MPA, PA-C, Branford, Conn.

As with all medications, anticholinergics must be used with greater caution in elderly patients. Side effects include dry mouth, blurred near vision, tachycardia, orthostasis, drowsiness, and constipation. Anticholinergics are also contraindicated in patients with angle closure glaucoma. Most clinicians are taught to avoid prescribing these drugs to older men for fear of precipitating acute urinary retention. However, recent studies show that men with urgency and no evidence of a significantly elevated postvoid residual volume (PVR) can be safely treated with anticholinergics. Side effects can be minimized with low doses of a short-acting agent such as tolterodine (Detrol) (or by using the extended-release formulation [Detrol LA]), an M-3-selective drug such as darifenacin (Enablex) or solifenacin (Vesicare), or a quaternary amine such as trospium (Sanctura). Men with a significantly elevated PVR should not be treated with these drugs until their obstruction has been relieved either medically or surgically. For further discussion, see Saini R and Kaplan SA. Lower urinary tract symptoms in men. In: Rose BD, ed. UpToDate. Wellesley, Mass.: UpToDate; 2009.—Reuben W. Zimmerman, PA-C (133-8)