From the Guidelines
Mirabegron is generally preferred over oxybutynin for overactive bladder treatment due to its more favorable side effect profile. Oxybutynin, an anticholinergic medication, commonly causes dry mouth, constipation, blurred vision, and cognitive effects, which often lead to discontinuation 1. Mirabegron, a beta-3 adrenergic agonist, works differently by relaxing the bladder muscle and causes fewer anticholinergic side effects 1. It may cause mild hypertension and is contraindicated in uncontrolled hypertension. For elderly patients especially, mirabegron is preferred as anticholinergics like oxybutynin can worsen cognitive function.
Some key points to consider when choosing between mirabegron and oxybutynin include:
- The potential for anticholinergic side effects with oxybutynin, which can be particularly problematic in elderly patients 1
- The efficacy of mirabegron in reducing symptoms of overactive bladder, as demonstrated in studies such as the BESIDE trial 1
- The importance of individualizing treatment choice based on patient characteristics, comorbidities, and cost considerations, as mirabegron is typically more expensive 1
- The need for a comprehensive approach to treatment, including bladder training and fluid management, in addition to medication 1
Overall, the choice between mirabegron and oxybutynin should be based on a careful consideration of the potential benefits and risks of each medication, as well as the individual needs and circumstances of the patient. Mirabegron is generally a better option due to its favorable side effect profile and efficacy in reducing symptoms of overactive bladder.
From the Research
Comparison of Oxybutinin and Mirabegron
- Oxybutinin and mirabegron are two medications used to treat overactive bladder (OAB) symptoms.
- According to a systematic review 2, mirabegron has been shown to be effective, safe, and well-tolerated in treating OAB symptoms, with significant improvements in urgency urinary incontinence, total incontinence, and nocturia.
- In a study comparing mirabegron to oxybutynin, mirabegron 50 mg was found to have significant changes in overall adverse events, favoring mirabegron 50 mg 2.
- Another study found that add-on therapy with mirabegron to solifenacin was well-tolerated and provided significant improvements in OAB symptoms 3.
- A review of mirabegron's efficacy, safety, and tolerability found that it has a different mechanism of action from antimuscarinic agents, such as oxybutynin, and has been shown to be effective in treating OAB symptoms with a favorable safety and tolerability profile 4.
- An analysis of a large integrated clinical trial database found that mirabegron was safe and effective in treating OAB symptoms, with improvements in efficacy parameters and a favorable safety and tolerability profile compared to antimuscarinics 5.
- A review of mirabegron's use in various patient populations, including men, the elderly, and those with poor tolerability to antimuscarinics, found that it represents a new treatment option for a broad range of patients with OAB 6.
Key Findings
- Mirabegron has been shown to be effective, safe, and well-tolerated in treating OAB symptoms.
- Mirabegron has a favorable safety and tolerability profile compared to antimuscarinics, such as oxybutynin.
- Add-on therapy with mirabegron to solifenacin or other antimuscarinics may provide significant improvements in OAB symptoms.
- Mirabegron represents a new treatment option for a broad range of patients with OAB, including men, the elderly, and those with poor tolerability to antimuscarinics.