What medications are used to treat bladder spasms?

From the Guidelines

Medications commonly used to treat bladder spasms include anticholinergics such as oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (VESIcare), and darifenacin (Enablex). These medications work by blocking acetylcholine receptors, which relaxes the bladder muscle and reduces involuntary contractions.

Key Medications

• Oxybutynin: typical dosing is 5 mg taken 2-3 times daily, while extended-release formulations may be taken once daily 1
• Tolterodine: similar efficacy to oxybutynin but with fewer harms 1
• Solifenacin: associated with the lowest risk for discontinuation due to adverse effects 1
• Darifenacin: had risks for discontinuation due to adverse effects similar to placebo 1

Alternative Options

• Beta-3 adrenergic agonists like mirabegron (Myrbetriq): typically dosed at 25-50 mg once daily, offer an alternative mechanism by promoting bladder relaxation through different receptors
• Botulinum toxin (Botox) injections: directly into the bladder wall can provide relief for several months for patients with neurogenic bladder spasms
• Tricyclic antidepressants such as amitriptyline: at low doses (10-25 mg at bedtime) may also help

Important Considerations

• Patients should start with lower doses to minimize side effects and should avoid these medications if they have certain conditions like glaucoma or urinary retention
• Lifestyle modifications such as timed voiding, pelvic floor exercises, and avoiding bladder irritants (caffeine, alcohol, spicy foods) should accompany medication therapy for optimal results 1

From the FDA Drug Label

1 INDICATIONS AND USAGE

1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.

The medication used to treat bladder spasms is mirabegron. It is indicated for the treatment of Overactive Bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 2.

• Key points:
  • Mirabegron is used to treat OAB symptoms
  • It is indicated for adult patients
  • Symptoms treated include urge urinary incontinence, urgency, and urinary frequency 2 does not directly answer the question about medications for bladder spasms, but 2 does.

From the Research

Bladder Spasm Medication

Medications used to treat bladder spasms include:

• Anticholinergic drugs, such as oxybutynin, tolterodine, trospium chloride, darifenacin, and solifenacin, which are often used as the first line of medical therapy for overactive bladder syndrome 3, 4
• Antimuscarinic agents, which can be used to treat overactive bladder symptoms in adults, including oxybutynin, tolterodine, trospium chloride, darifenacin, and solifenacin 4
• Oxybutynin chloride, which has been used in controlled clinical studies to treat neurovesical reflex activity, uninhibited bladders, enuresis, and primary muscle spasm 5

Treatment Approaches

Treatment approaches for bladder spasms and overactive bladder may involve:

• Behavioral therapy as a first choice for management 6
• Pharmacologic treatment, including anticholinergics and β3-adrenoceptor agonists, as second-line treatment 6
• OnabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation as third-line therapy for patients refractory or intolerant to first- and second-line treatments 6

Comparison of Anticholinergic Drugs

A network meta-analysis of randomised controlled trials found that:

• There was no clearly best treatment for cure or improvement among anticholinergic drugs 7
• Transdermally delivered oxybutynin was the best treatment for dry mouth, but was still worse than placebo 7
• All anticholinergic drugs were better than placebo, but apart from dry mouth, were similar in effect 7