From the Guidelines
Medications for urge incontinence should primarily include antimuscarinic medications or beta-3 agonists, as they have been shown to improve urinary urgency, frequency, and/or urgency urinary incontinence. According to the most recent guideline, antimuscarinic medications or beta-3 agonists are recommended as the first-line treatment for patients with overactive bladder 1. The choice of medication should be based on the patient's individual needs, tolerability, and potential side effects. Some examples of antimuscarinic medications include oxybutynin, tolterodine, solifenacin, darifenacin, and trospium, which work by blocking acetylcholine receptors in the bladder, reducing involuntary contractions. Beta-3 agonists, such as mirabegron, relax the bladder muscle through a different mechanism and may cause fewer side effects than anticholinergics, particularly dry mouth and constipation 1. Treatment typically begins with lower doses and increases if needed after 4-6 weeks. Anticholinergics should be used cautiously in older adults due to potential cognitive side effects. Combination therapy with an anticholinergic and mirabegron may be considered for patients with inadequate response to single agents. These medications work best when combined with behavioral techniques like timed voiding, fluid management, and pelvic floor exercises. Patients should expect gradual improvement over several weeks rather than immediate results, and should continue treatment for at least 3 months to evaluate effectiveness. It's worth noting that while older studies also support the use of these medications, the most recent guideline provides the strongest evidence for their effectiveness 1.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. Solifenacin succinate tablets are indicated for the treatment of adults with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.
Medication options for urge incontinence include:
- Mirabegron (2)
- Solifenacin (3)
Key points:
- These medications are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- The recommended dosage and administration instructions vary depending on the medication and patient population.
From the Research
Medication Options for Urge Incontinence
- Anticholinergic medications are a common treatment option for urge incontinence, but they can have adverse effects, particularly in older adults 4, 5.
- Mirabegron and onabotulinumtoxinA are alternative medication options for treating urge incontinence 4.
- Oxybutynin is often recommended as a first-line treatment for overactive bladder and urgency incontinence, but it can have deleterious cognitive effects, especially in frail older people 5.
- Combined antimuscarinic treatment, such as oxybutynin with trospium or solifenacin, may be an option for patients with neurogenic bladder refractory to previous antimuscarinic monotherapy 6.
- Other antimuscarinic agents, such as propiverine, tolterodine, darifenacin, trospium, imidafenacin, and fesoterodine, are also used to treat overactive bladder, but their efficacy and safety profiles may vary 7.
- The extended-release form of oxybutynin and transdermal transport system have improved its tolerability and safety profile, but intravesical instillation of oxybutynin requires further study to determine its efficacy and safety 8.
Considerations for Treatment
- The choice of medication should be based on the individual patient's needs and medical history, taking into account potential adverse effects and interactions with other medications 4, 5, 7.
- Patients with cognitive impairment or frailty may require closer monitoring and alternative treatment options 5.
- Combination therapy may be considered for patients who do not respond to monotherapy, but the risks and benefits should be carefully weighed 6.