From the Guidelines
The first-line treatment for neurogenic detrusor overactivity is antimuscarinic medications, specifically oxybutynin, as indicated by the study published in The Journal of Urology in 2016 1. The recommended dose of oxybutynin is 0.2 mg/kg orally given 3 times daily, as noted in the study 1. Key points to consider when prescribing oxybutynin include:
- Starting with a lower dose and titrating upward based on efficacy and tolerability
- Monitoring for common side effects such as dry mouth, constipation, and blurred vision
- Using caution in patients with narrow-angle glaucoma, significant bladder outlet obstruction, or cognitive impairment
- Regular follow-up to assess treatment response and manage side effects It is essential to note that if oxybutynin is ineffective or poorly tolerated, alternative antimuscarinic agents or beta-3 adrenergic agonists like mirabegron may be considered as an alternative or add-on therapy, although the study 1 specifically mentions oxybutynin as the treatment for detrusor overactivity in patients with neurogenic bladder.
From the FDA Drug Label
Mirabegron for Pediatric Neurogenic Detrusor Overactivity (NDO) The safety of mirabegron was evaluated in a 52-week, open-label, baseline-controlled, multicenter, dose titration study (Study 9) [see Clinical Studies (14. 3)]. The study included 86 pediatric patients 3 to 17 years of age with neurogenic detrusor overactivity (NDO); 55% were female, 72% were White.
The first-line treatment for neurogenic detrusor overactivity is mirabegron 2.
- Key points:
- Mirabegron is used to treat neurogenic detrusor overactivity (NDO) in pediatric patients.
- The safety of mirabegron was evaluated in a 52-week study in pediatric patients with NDO.
- Mirabegron is a viable treatment option for NDO, with a notable safety profile in pediatric patients.
From the Research
First-Line Treatment for Neurogenic Detrusor Overactivity
The first-line treatment for neurogenic detrusor overactivity typically involves the use of antimuscarinic drugs, as they are considered the standard treatment for detrusor overactivity (DO) 3, 4.
- Antimuscarinic drugs work by inhibiting the muscarinic receptors in the bladder, which helps to reduce the symptoms of detrusor overactivity.
- However, these drugs can have side effects and may not be effective for all patients, leading to the need for alternative treatments 3, 4.
- Other treatment options, such as beta-3 agonists (e.g., mirabegron), have shown promise in treating neurogenic detrusor overactivity, particularly in patients who have not responded to antimuscarinic therapy 5, 4.
Alternative Treatment Options
In addition to antimuscarinic drugs, other treatment options are available for neurogenic detrusor overactivity, including:
- Beta-3 agonists, such as mirabegron, which have been shown to be effective in reducing the frequency of bladder evacuation and incontinence episodes 5.
- External temporary electrostimulation, which has been found to be a useful second-line treatment option for patients with idiopathic or neurogenic detrusor overactivity who have not responded to antimuscarinic therapy 3.
- Increasing the dosage of antimuscarinic drugs, which has been found to be effective in some patients with neurogenic detrusor overactivity who have not responded to standard dosages 6.
Treatment Considerations
When considering treatment options for neurogenic detrusor overactivity, it is essential to take into account the individual patient's needs and medical history, as well as the potential side effects and efficacy of each treatment option 7, 4.
- A thorough evaluation of the patient's condition, including urodynamic studies and bladder diaries, can help to determine the most effective treatment approach.
- Patients should be closely monitored for side effects and treatment efficacy, and adjustments to the treatment plan should be made as needed.