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Overactive bladder (OAB) can be debilitating and negatively affect quality of life5

OAB symptoms can be very distressing and embarrassing for patients, as well as disrupting normal daily functioning and reducing independence.5

A large proportion of OAB patients may remain untreated6

Of 1,916 men and women aged 40-74 years with bothersome OAB symptoms, 60% had spoken to a doctor, but only 27% of these (16% of the total cohort) were currently on medication.6

Typical management pattern for overactive bladder (OAB)7

Adapted from Chancellor M B et al, 20147

Oral OAB therapies typically have a low retention rate8-11

The majority of patients with OAB discontinue oral therapies9,10

ACH cycling can be associated with high discontinuation rates12

  • Of a cohort of 620 patients initiating ACH therapy, 71% had discontinued by the end of the study period (3 years).12
  • ACHs are commonly used after, or combined with, behavioural therapy as first-line medication for OAB management.7 However, there is emerging evidence about the risks associated with long-term ACH use, particularly in older patients.13
Cognitive impairment Dementia

The central nervous systems of older patients (>65 years) may be sensitive to ACH-related adverse effects.13,14 

Use of medications with medium or high ACH activity was associated with deficits of memory, executive function, cognitive performance and increased risk of clinical cognitive impairment.15,16 

Higher cumulative ACH use in older patients was associated with an increased risk of dementia.7 Concurrent use of multiple ACH medications in older adults was associated with greater risk of hospitalisation for confusion.17

ACH, anticholinergic; OAB: overactive bladder, PTNS: percutaneous tibial nerve stimulation; SNM: sacral nerve modulation.

BOTOX® is indicated for the management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: overactive bladder with symptoms of urinary incontinence, urgency and frequency.18



  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of onabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan Ltd. Data on file 014
  5. Sievert K D, Chapple C et al. OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder. Int J Clin Pract 2014;68(10):1246-1256
  6. Milsom I, Abrams P et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001;87(9):760-766
  7. Chancellor M B, Levanovich P et al. Optimum management of overactive bladder: medication vs Botox® vs InterStim® vs Urgent® PC. Urol Pract 2014;1:7–12
  8. Castro D, Miranda P et al. Assessment of reasons for overactive bladder treatment change. Actas Urol Esp 2011;35(2):73-79
  9. D'Souza A O, Smith M J et al. Persistence, adherence, and switch rates among extended-release and immediate-release overactive bladder medications in a regional managed care plan. J Manag Care Pharm 2008;14(3):291-301
  10. Wagg A, Compion G et al. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BJU Int 2012;110(11):1767-1774
  11. Pindoria N, Malde S et al. Persistence with mirabegron therapy for overactive bladder: A real life experience. Neurourol Urodyn 2015;36(2):404-408
  12. Chancellor M B, Yehoshua A et al. Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study. Int Urol Nephrol 2016;48(7):1029-1036
  13. Gray S L, Anderson M L et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 2015;175(3):401-407
  14. Campbell N, Boustani M et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging 2009;4:225-233
  15. Lechevallier-Michel N, Molimard M et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol 2005;59(2):143-151
  16. Risacher S L, McDonald B C et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol 2016;73(6):721-732
  17. Kalisch Ellett L M, Pratt N L et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc 2014;62(10):1916-1922
  18. BOTOX® Summary of Product Characteristics. Available at: Accessed April 2022

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.


Adverse events should be reported. Reporting forms and information can be found at

Adverse events should also be reported to AbbVie on [email protected] 


Date of preparation: April 2022. UK-BUO-220008.