From the Guidelines
Patients with Overactive Bladder (OAB) can be treated with alternative medications, including Tolterodine (Detrol), Solifenacin (Vesicare), Darifenacin (Enablex), Fesoterodine (Toviaz), and Trospium (Sanctura), as second-line therapy, as recommended by the AUA/SUFU guideline 1. These medications are all anticholinergics, which work by relaxing the bladder muscles and reducing involuntary contractions.
- Dosages vary by medication, but they are typically taken once or twice daily.
- Common side effects may include dry mouth, constipation, and blurred vision.
- Patients should be aware that these medications can take several weeks to reach full effectiveness.
- These drugs work by blocking acetylcholine receptors in the bladder, which reduces muscle spasms and increases bladder capacity, helping to decrease urgency, frequency, and incontinence associated with OAB. When prescribing antimuscarinic medications, clinicians should use extreme caution in patients with narrow-angle glaucoma, impaired gastric emptying, or a history of urinary retention, as stated in the 2024 AUA/SUFU guideline 1.
- Additional considerations should be given to patients with diabetes, prior abdominal surgery, narcotic use, scleroderma, hypothyroidism, Parkinson’s disease, multiple sclerosis, and any other conditions that may impact gastric emptying. It is essential to carefully evaluate the body of evidence supporting the use of antimuscarinic medications in patients with a history of urinary retention or those at risk for urinary retention, as recommended by the 2024 AUA/SUFU guideline 1.
From the Research
Medications for Overactive Bladder (OAB)
Other than Myrbetriq (Mirabegron) and Oxybutynin, the following medications are used to treat OAB:
- Anticholinergic (antimuscarinic) drugs, such as:
- Beta-3 agonists, which have been shown to be effective in reducing nocturia episodes 4
- Onabotulinumtoxin-A (Onabot-A) bladder injections, which have been shown to be effective in reducing urgency urinary incontinence (UUI) episodes 4
- Vaginal estrogen, which can be suggested for subjective improvements in OAB symptoms 2
Pharmacological Treatment Options
The choice of pharmacological treatment for OAB should be guided by individual patient characteristics, including comorbidities and potential side effects 2, 3. Antimuscarinic agents, such as oxybutynin, tolterodine, and trospium chloride, are commonly used to treat OAB, but may have adverse effects, such as dry mouth, constipation, and cognitive impairment 5, 3.
Treatment Guidelines
The European Association of Urology and other organizations have published guidelines for the management of OAB, which recommend a stepwise approach to treatment, including conservative measures, pharmacological treatment, and surgical options 4, 6. The guidelines emphasize the importance of individualizing treatment based on patient characteristics and preferences.