Speak Out: What steps do you take to improve compliance with anticholinergic drugs?

"If patients are non-compliant, it's usually because their symptoms are not too bothersome. If their symptoms aren't that bothersome, I don't press the issue.

If side effects are the issue, we'll look for something that is more tolerable because there are so many anticholinergics out there. If it's the cost, we'll look for something cheaper or a medication that may be covered by their insurance, because cost has been a huge factor recently.

Elmer Pineda, MD
Pomona, CA

"I educate patients about side effects, and encourage them to stick with it.

If the side effects are too much for the patient, we either discontinue, move on, or switch to an alternative drug or treatment.

If it is a medical issue, you have to tell them they're going to have bigger problems if they aren't compliant. They may have to use lozenges or take laxatives to deal with constipation."

Glenn Gmyrek, MD
Wayne, NJ

"If they have too many side effects, it can be difficult to convince them. We'll even call them up to remind them.

If cost is a factor, we help them get benefits from the drug companies, reduce their copays, or provide free drugs if they furnish their tax statements. If there are medical issues, we'll change dosing or work with mechanical devices to catch the urine."

Frank Greco, MD
Pittsburgh

"Some people need anticholinergics for neurogenic bladders with spinal cord injuries and multiple sclerosis to protect their kidneys. If there are side effects and they really need them, I would talk about some of the other options, possibly botulinum toxin A or bladder augmentation.

Some people don't like to take a pill every day. There are stimulation devices some people prefer.

That's a different issue than someone who wants an anticholinergic so they can urinate a few times less often at work but don't need it to protect their kidneys. If it's just for convenience and they don't take it, there's no harm done. There are also pelvic floor exercises they can do,and behavioral therapy.

If it's a quality of life issue, I emphasize that it works as long as they take it. I may switch them to one of the numerous other drugs out there."

Elliot Fagelman, MD
Pomona, NY