From the Guidelines
Mirabegron is not typically needed after tolterodine unless specifically prescribed by a healthcare provider, as it is usually considered when other overactive bladder medications haven't been effective or caused intolerable side effects. Mirabegron (brand name Myrbetriq) is a medication used to treat overactive bladder (OAB) symptoms such as frequent urination, urgency, and incontinence. It works by relaxing the bladder muscle to increase its capacity. The standard dose is 25 mg once daily, which can be increased to 50 mg if needed after 8 weeks. According to the 2019 guideline amendment by the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) 1, combination therapy with solifenacin and mirabegron has shown efficacy in reducing urinary incontinence episodes and micturitions per 24 hours, but this does not directly apply to the use of mirabegron after tolterodine.
Key Considerations
- The AUA/SUFU guideline amendment 1 suggests that combination therapy with solifenacin and mirabegron may be effective, but it does not provide direct evidence for the use of mirabegron after tolterodine.
- A previous guideline statement 1 recommends trying a different anti-muscarinic medication or a b3-adrenoceptor agonist, such as mirabegron, if a patient experiences inadequate symptom control or unacceptable adverse events with one anti-muscarinic medication.
- The decision to add mirabegron to a treatment regimen should be made on a case-by-case basis, taking into account the patient's specific situation, current medications, and symptoms.
Important Factors to Discuss with a Healthcare Provider
- Current medications and their effectiveness
- Side effects experienced with current medications
- Specific symptoms and their impact on quality of life
- Potential benefits and risks of adding mirabegron to the treatment regimen
It's crucial to consult a healthcare provider to determine if mirabegron is appropriate and safe for a specific patient, as they can evaluate the individual's situation and make an informed decision based on the latest evidence and guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Efficacy of Mirabegron After Tolterodine
- Mirabegron has been shown to be an effective treatment for overactive bladder (OAB) symptoms, with significant improvements in micturition frequency, urgency incontinence, and urgency 2, 3, 4, 5, 6.
- Studies have demonstrated that mirabegron is as effective as antimuscarinic therapy, such as tolterodine, in treating OAB symptoms, but with fewer common, bothersome side effects such as dry mouth, constipation, and urinary retention 2, 3, 5.
- A post hoc analysis of a randomized European-Australian Phase 3 trial found that mirabegron provided treatment benefits in OAB patients who were antimuscarinic treatment-naïve and in patients who had received prior antimuscarinic treatment, including those who had discontinued due to insufficient efficacy or poor tolerability 4.
Comparison with Tolterodine
- Mirabegron has been compared to tolterodine in several studies, with results showing that mirabegron is as effective as tolterodine in reducing OAB symptoms, but with a more favorable safety and tolerability profile 3, 5.
- A study found that the incidence of dry mouth was similar to placebo and was between three and fivefold less than for tolterodine extended release 4 mg 3.
- Another study found that mirabegron did not demonstrate noninferiority in reducing micturition frequency compared to solifenacin, but had a numerically lower incidence of dry mouth than antimuscarinics 5.
Patient Populations
- Mirabegron has been shown to be effective in a variety of patient populations, including men, the elderly, and those with poor tolerability to antimuscarinics 5, 6.
- A review of mirabegron for the treatment of OAB found that the drug has a favorable safety and tolerability profile, particularly compared with antimuscarinics, and represents a new treatment option for a broad range of patients with OAB 6.