What medications are used to manage bladder spasm pain?

From the Guidelines

Oxybutynin is the most effective medication for managing bladder spasm pain, with a recommended dose of 0.2 mg/kg TID, as it has been shown to be effective in reducing hostile bladder symptoms in patients with spina bifida 1. When managing bladder spasm pain, several medications can be used, including:

• Anticholinergics: oxybutynin (0.2 mg/kg TID) is the most commonly recommended medication for bladder spasm pain, as seen in patients with spina bifida 1
• Other anticholinergic medications, such as solifenacin, tolterodine, and trospium chloride, may also be effective, but oxybutynin is the most studied and recommended medication in this context 1
• Beta-3 agonists, such as mirabegron, may be considered as an alternative to anticholinergics, but there is limited evidence to support their use in bladder spasm pain specifically
• Antispasmodics, such as flavoxate, and muscle relaxants, such as baclofen, may provide immediate pain relief, but their use is not as well established as oxybutynin in this context
• Tricyclic antidepressants, such as amitriptyline, may be effective in chronic bladder pain, but their use is not specifically recommended for bladder spasm pain It is essential to note that the medication of choice may vary depending on the individual patient's condition and response to treatment, and patients should discuss potential drug interactions and side effects with their healthcare provider before beginning treatment.

From the FDA Drug Label

Anticholinergic agents may potentially alter the absorption of some concomitantly administered drugs due to anticholinergic effects on gastrointestinal motility. Oxybutynin chloride showed no increase of mutagenic activity when tested in Schizosaccharomyces pompholiciformis, Saccharomyces cerevisiae and Salmonella typhimurium test systems. The safety and efficacy of oxybutynin chloride administration have been demonstrated for pediatric patients 5 years of age and older Treatment with oxybutynin chloride tablets was associated with an increase from baseline in mean urine volume per catheterization from 122 mL to 145 mL, an increase from baseline in mean urine volume after morning awakening from 148 mL to 168 mL, and an increase from baseline in the mean percentage of catheterizations without a leaking episode from 43% to 61%. Urodynamic results in these patients were consistent with the clinical results Treatment with oxybutynin chloride tablets was associated with an increase from baseline in maximum cystometric capacity from 230 mL to 279 mL, a decrease from baseline in mean detrusor pressure at maximum cystometric capacity from 36 cm H2O to 33 cm H2O, and a reduction in the percentage of patients demonstrating uninhibited detrusor contractions (of at least 15 cm H2O) from 39% to 20%

Oxybutynin is used to manage bladder spasm pain, as it has been shown to increase urine volume and reduce detrusor pressure, thereby alleviating symptoms of bladder spasms 2.

• Key benefits of oxybutynin include increased urine volume per catheterization and reduced leaking episodes.
• Clinical efficacy has been demonstrated in pediatric patients 5 years of age and older.
• Dosage should be cautious in elderly patients due to potential prolongation of elimination half-life.

From the Research

Medications for Bladder Spasm Pain

• Anticholinergic drugs are commonly used to treat overactive bladder symptoms, which can include bladder spasm pain 3
• Specific medications used to manage bladder spasm pain include:
  • Oxybutynin
  • Tolterodine
  • Solifenacin
  • Fesoterodine
  • Trospium chloride
  • Darifenacin

Comparison of Medications

• Tolterodine and oxybutynin have been compared in several studies, with tolterodine showing similar efficacy but fewer adverse events 3, 4, 5
• Solifenacin has been shown to be more effective than tolterodine in some studies, but with a higher risk of dry mouth 3
• Fesoterodine has been shown to be more effective than extended release tolterodine, but with a higher risk of adverse events 3

Management of Post-Operative Bladder Spasm

• Intravesical bupivacaine has been used to manage post-operative bladder spasm in children, with good effect 6
• Other methods of management, such as epidural anaesthesia and intravenous morphine, have also been used to manage post-operative bladder spasm 6

Considerations for Elderly Patients

• Antimuscarinic therapy is commonly used to treat overactive bladder in elderly patients, but may be underutilized due to concerns about adverse events 7
• When selecting an antimuscarinic agent for an elderly patient, considerations should include evidence of clinical efficacy and tolerability, as well as safety issues specific to an older population 7