Management of use of urinary antimuscarinics and alpha blockers for benign prostatic hyperplasia in older adults at risk of falls: a clinical review
Abstract
Aim: To review the current knowledge and the underlying pathophysiology of fall risk associated with the use of urinary antimuscarinics and alpha-blockers in older adults and help clinicians in (de-)prescribing urinary antimuscarinics and alpha-blockers. Findings: Untreated overactive bladder and/or benign prostatic hyperplasia increase fall risk in older adults and so do urinary antimuscarinics and/or alpha-blockers.
These drugs contribute to (or cause) falling through dizziness, somnolence, visual impairment, and orthostatic hypotension while they differ in these fall-related side effect profiles. While considering withdrawal of urinary antimuscarinics and alpha-blockers is recommended for older adults under high fall risk, physicians are frequently hesitant to deprescribe these drugs.
There are practical resources and algorithms that guide and assist clinicians in deprescribing these drug groups. Message: Comprehension of fall-related side effect profiles of antimuscarinics and alpha-blockers and clinical decision tools such as the STOPPFall withdrawal algorithm help prescribers in attaining rational decisions while (de-)prescribing.