How to manage increased urinary frequency in a geriatric patient taking Gemtesa (vibegron) 75mg daily?

From the Guidelines

To manage increased urinary frequency in a geriatric patient taking Gemtesa (vibegron) 75mg daily, consider discussing with the prescribing physician about timing adjustments of the medication or possibly reducing the dose temporarily to 50mg if symptoms are severe, while also implementing lifestyle modifications such as bladder training and pelvic floor exercises. The patient should take the medication at the same time each day with a full glass of water, and maintain good hydration throughout the day but reduce fluid intake 2-3 hours before bedtime to help manage symptoms 1. Suggest bladder training techniques such as scheduled voiding every 2-3 hours while awake and gradually increasing the time between voids. Pelvic floor exercises (Kegels) performed 3 times daily (10-15 repetitions each session) can strengthen urinary control. It's essential to note that Gemtesa works by relaxing the bladder muscle and typically improves urinary frequency rather than worsening it, so increased frequency might indicate an underlying urinary tract infection or another condition that should be evaluated 1. The full therapeutic effect of Gemtesa may take 8 weeks, so some patience may be required if treatment was recently initiated. When reviewing the need for existing or new medications, consider the remaining life expectancy, time to benefit, and goals of care for the individual elderly patient, and prioritize which long-term medications are most likely to produce benefit and least likely to harm the patient 1. In older patients with a short life expectancy or with advanced diseases, treatment of CVD until death and/or use of secondary prevention medications that take several years to provide benefits may no longer be beneficial or appropriate. The preservation of functional independence and quality of life, and the alleviation of distressing symptoms, should be the primary focus in managing geriatric patients with increased urinary frequency.

From the Research

Management of Increased Urinary Frequency in Geriatric Patients Taking Gemtesa (Vibegron) 75mg Daily

• The patient's increased urinary frequency while taking Gemtesa (vibegron) 75mg daily may be managed by adjusting the treatment regimen or adding other medications.
• According to the study 2, antimuscarinic therapy, such as oxybutynin, tolterodine, trospium chloride, darifenacin, and solifenacin, is commonly used to treat overactive bladder (OAB) symptoms, including urinary frequency.
• However, the study 2 also notes that antimuscarinics can have adverse effects, such as dry mouth, cognitive impairment, and sleep disturbances, particularly in elderly patients.
• An alternative approach is to use a β3-adrenergic agonist, such as mirabegron, which has been shown to be effective in reducing OAB symptoms, including urinary frequency, with fewer adverse effects compared to antimuscarinics 3.
• Combination therapy with mirabegron and solifenacin has been shown to be effective in reducing OAB symptoms, including urinary frequency, and improving quality of life, with a tolerable safety profile 4, 5, 6.
• The study 3 suggests that mirabegron may be a better initial treatment option for OAB patients, with solifenacin added if necessary, due to its favorable safety profile.
• The study 6 recommends mirabegron plus solifenacin as a treatment option for patients with OAB, citing its efficacy and safety in reducing symptoms and improving quality of life.

Considerations for Geriatric Patients

• When managing increased urinary frequency in geriatric patients taking Gemtesa (vibegron) 75mg daily, it is essential to consider the patient's overall health, medical history, and potential interactions with other medications.
• The study 2 highlights the importance of selecting an antimuscarinic agent that is safe and effective for elderly patients, taking into account the potential for adverse effects, such as cognitive impairment and sleep disturbances.
• Geriatric patients may require closer monitoring and dose adjustments due to age-related changes in drug metabolism and excretion.