Is Oxybutynin on the Beers Criteria?
Yes, oxybutynin is explicitly listed on the American Geriatrics Society Beers Criteria as a potentially inappropriate medication for older adults due to its strong anticholinergic properties. 1
Why Oxybutynin Is Included
Oxybutynin is specifically identified as an anticholinergic medication that should be avoided in older adults to prevent delirium and other adverse outcomes. 1 The 2019 AGS Beers Criteria includes 30 individual medications or medication classes to avoid in older adults, and anticholinergics like oxybutynin are prominently featured due to their unfavorable risk-benefit profile. 1
Specific Risks in Older Adults
Cognitive impairment and delirium: Oxybutynin binds nonspecifically to muscarinic receptors in the brain and is associated with impaired memory, cognition, and increased risk of incident dementia. 2
Falls and fractures: The American Geriatrics Society recommends avoiding anticholinergics in patients with a history of falls or fractures. 3
Dementia concerns: The American Geriatrics Society recommends avoiding anticholinergics in patients with dementia or cognitive impairment. 3, 4
Clinical Context
Despite being on the Beers Criteria, oxybutynin remains widely prescribed—accounting for more than half of all overactive bladder medication prescriptions, with 56.3% of antimuscarinic users receiving oxybutynin. 2, 5 This represents a significant gap between evidence-based recommendations and real-world practice.
What to Do Instead
Avoid oxybutynin as first-line therapy in older adults. 1, 3 When treating overactive bladder in this population:
Consider selective antimuscarinics (solifenacin, darifenacin) over non-selective agents like oxybutynin, though all antimuscarinics carry some risk. 5
Prioritize non-pharmacological approaches first, including behavioral modifications and pelvic floor therapy. 6
If anticholinergics must be used, choose agents with lower CNS penetration and monitor closely for cognitive changes. 6, 2
Common Pitfall
The most critical error is continuing to prescribe oxybutynin simply because it has been used historically or is inexpensive, without considering the substantial cognitive and safety risks in older adults. 2 The high discontinuation rate (up to 25%) due to anticholinergic side effects further underscores its poor tolerability. 7