Propiverine hydrochloride

How it works

It combines antimuscarinic blockade of bladder muscarinic receptors with a degree of direct smooth muscle (calcium-modulating) relaxant activity, reducing detrusor overactivity and increasing bladder capacity.

Prescribing in practice

• It is contraindicated in conditions such as urinary retention, gastric retention, significant gastrointestinal obstruction, angle-closure glaucoma and myasthenia gravis.
• Use cautiously in older patients and those with autonomic neuropathy, hepatic or renal impairment, or cardiac arrhythmia, with attention to anticholinergic burden.
• It may impair the ability to drive or operate machinery because of drowsiness and blurred vision.

Monitoring

Review symptom response after an adequate trial and monitor for anticholinergic adverse effects, residual urine volume and cognitive effects in vulnerable patients.

Counselling the patient

• Be aware of dry mouth, constipation and blurred vision, and report inability to pass urine.
• Do not drive or use machinery if you feel drowsy or your vision is blurred.

Evidence & guidelines

Antimuscarinics are recommended by NICE for overactive bladder when conservative measures are insufficient; see current guidance for choice and review.