From the Guidelines
The most effective medication for overactive bladder is mirabegron (Myrbetriq), a beta-3 adrenergic agonist, which works by relaxing the bladder muscle, typically started at 25mg daily, as recommended by the latest guidelines 1. When treating overactive bladder, several medications are available, including anticholinergics such as oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (VESIcare), darifenacin (Enablex), fesoterodine (Toviaz), and trospium chloride (Sanctura) 1.
- Typical starting doses for anticholinergics are low, such as oxybutynin 5mg twice daily or tolterodine 2mg twice daily, with adjustments based on response and side effects.
- Another effective option is mirabegron (Myrbetriq), which works differently by relaxing the bladder muscle, typically started at 25mg daily.
- These medications work by blocking the nerve signals that trigger bladder contractions, reducing urgency, frequency, and urge incontinence.
- Common side effects of anticholinergics include dry mouth, constipation, and blurred vision, while mirabegron may cause high blood pressure.
- Treatment typically continues long-term as symptoms often return when medication is stopped.
- Patients should also consider lifestyle modifications like fluid management, bladder training, and pelvic floor exercises alongside medication for optimal results, as outlined in the latest guidelines 1.
- The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) recommend a stepwise approach to treatment, starting with lifestyle modifications and behavioral therapies, followed by pharmacologic therapies, and finally minimally invasive and invasive therapies if necessary 1.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. Tolterodine tartrate tablets are a prescription medicine for adults used to treat the following symptoms due to a condition called overactive bladder: Urge urinary incontinence: a strong need to urinate with leaking or wetting accidents Urgency: a strong need to urinate right away Frequency: urinating often
The medications for overactive bladder are:
From the Research
Medications for Overactive Bladder
The medications for overactive bladder can be categorized into several types, including:
- Antimuscarinic medications, such as oxybutynin 4, tolterodine 5, and trospium 6, which work by blocking the binding of acetylcholine to muscarinic receptors in the bladder
- β3-adrenergic agonists, such as vibegron 7, which increase the capacity of the bladder and reduce the number of daily micturitions and nocturia
- Other medications, such as solifenacin and darifenacin 6, which are more selective for the bladder than older agents and have been shown to improve quality of life in women with overactive bladder and urinary incontinence
Comparison of Medications
Studies have compared the efficacy and tolerability of different medications for overactive bladder, including:
- A study that found tolterodine to be as effective as oxybutynin, but better tolerated 5
- A study that found solifenacin to produce a somewhat greater decrease in the number of incontinence episodes than extended-release tolterodine, with no difference in tolerability 6
- A study that found newer agents, such as trospium, solifenacin, and darifenacin, to be at least as effective as their predecessors, although it is unclear whether they are better tolerated 6
New Treatment Options
Researchers are also investigating new treatment options for overactive bladder, including: