From the Guidelines
Mirabegron is generally well-tolerated in the elderly, but its use requires careful consideration due to potential side effects such as hypertension, UTIs, headache, and nasopharyngitis, as reported in a 2023 meta-analysis of eight randomised controlled trials 1. When prescribing mirabegron to elderly patients, particularly those with dementia, it is essential to monitor their blood pressure closely, as the medication can cause hypertension, which is a concern in this population. Some key points to consider when using mirabegron in elderly patients and those with dementia include:
- The most frequent adverse events (AEs) associated with mirabegron are hypertension, UTIs, headache, and nasopharyngitis 1.
- Mirabegron is contraindicated in patients with severe uncontrolled hypertension, which is a critical consideration in elderly patients who may already have hypertension 1.
- The medication does not affect voiding urodynamic parameters, and the overall change in post-void residual (PVR) is small, which is beneficial in elderly patients who may have existing urinary retention issues 1.
- Long-term data on the efficacy and safety of mirabegron in men of any age with lower urinary tract symptoms (LUTS) are not available, which highlights the need for ongoing monitoring and assessment in elderly patients 1.
From the FDA Drug Label
Of 5,648 patients who received mirabegron monotherapy in the phase 2 and 3 studies for OAB, 2,029 (35.9%) were 65 years of age or older, and 557 (9. 9%) were 75 years of age or older. No overall differences in safety or effectiveness were observed between patients younger than 65 years of age and those 65 years of age or older in these studies.
The potential side effects of mirabegron in the elderly and dementia patients are not directly addressed in the provided drug labels. However, it is mentioned that no overall differences in safety or effectiveness were observed between patients younger than 65 years of age and those 65 years of age or older in the studies.
- Key points:
- No specific information on dementia patients
- No overall differences in safety or effectiveness in patients 65 years of age or older
- Studies did not specifically evaluate mirabegron in dementia patients 2
From the Research
Mirabegron Potential Side Effects for Elderly and Dementia
- The studies 3, 4 suggest that mirabegron is effective in treating overactive bladder symptoms in elderly patients, including those with dementia, with minimal side effects.
- Common side effects reported in these studies include dizziness and dysuria, but no significant changes were noted in post-void residual, maximum flow rate, and voided volume after treatment 3.
- A study 4 found that mirabegron improved symptoms of overactive bladder in patients aged ≥65 years with minimal side effects, similar to those already known for mirabegron.
- In contrast, anticholinergic drugs used to treat overactive bladder have been associated with an increased risk of dementia in older adults 5, 6.
- A study 7 found that treatment with mirabegron for 12 weeks did not contribute to drug-related cognitive side effects in patients aged ≥65 years, as measured by the Montreal Cognitive Assessment (MoCA).
- The available evidence suggests that mirabegron may be a safer alternative to anticholinergic drugs for treating overactive bladder in elderly patients, including those with dementia, due to its lower risk of cognitive side effects 5, 6, 7.