American Urogynecologic Society

View all recommendations from this society

Released June 24, 2020

Avoid using anticholinergic medication to treat overactive bladder in women older than 70.

Anticholinergic medications block acetylcholine at muscarinic receptors, which are present throughout the body. These medications have many side
effects, including impaired cognition, drowsiness and constipation.” Several cohort studies have raised concern regarding an association between
higher exposure to anticholinergics and increased risk of dementia. Given this, beta-3 agonists or 3rd line therapies should be preferentially utilized
when possible. When anticholinergics cannot be avoided, the lowest effective dose of anticholinergic should be used, and consideration should be
given to decreasing the dose of other concurrent anticholinergic medications

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Clinical Practice Committee of the American Urogynecologic Society (AUGS) reviewed clinical evidence to identify possible topics along with suggestions for possible topics from the AUGS Board of Directors. By consensus, the Clinical Practice Committee selected the top five most overused tests within specified parameters. Additional input was sought from the AUGS Board of Directors and incorporated. The final list was reviewed and approved by the AUGS Board of Directors.

AUGS’ listing of board and committee members and conflict of interest policy can be found at


ResourcesAmerican Association of Urogynecologic Surgery Consensus Statement: Association of Anticholinergic Medication Use and Cognition in Women with Overactive Bladder. Female Pelvic Medicine & Reconstructive Surgery. 2017 May/June;23(3):177-178.

Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. Journal of the American Medical Association Internal Medicine 2015 Mar;175:401–407.

Risacher SL, McDonald BC, Tallman EF, West JD, Farlow MR, Unverzagt FW, Gao S, Boustani M, Crane PK, Peterson RC, Jack CR Jr, Jagust WJ, Aisen PS, Weiner MW, Saykin AJ; Alzheimer’s Disease Neuroimaging Initiative. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. Journal of the American Medical Association Neurology 2016 Jun;73:721–732.

Richardson K, Fox C, Maidment I. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018 Apr 25;361:k1315. doi:  10.1136/bmj.k1315. PMCID: PMC5915701. PMID: 2969548

Coupland CAC1, Hill T1, Dening T2, Morriss R2, Moore M3, Hippisley-Cox J. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study.

JAMA Intern Med. 2019 Jun 24. doi: 10.1001/jamainternmed.2019.0677.

Welk B, McArthur E. Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU Int. 2020 Mar 13. doi: 10.1111/bju.15040.

Wang YC, Chen YL, Huang CC.Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study. BMC Geriatr. 2019 Dec 30;19(1):380. doi: 10.1186/s12877-019-1401-y.

Andre L, Gallini A, Montastruc F. Association between anticholinergic drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review.Eur J Clin Pharmacol. 2019 Dec;75(12):1631-1644. doi: 10.1007/s00228-019-02744-8. Epub 2019 Aug 29.