From the Guidelines
Medications commonly used to treat overactive bladder include anticholinergics and beta-3 adrenergic agonists, with antimuscarinic medications or beta-3 agonists being the recommended treatment options according to the most recent guidelines.
Treatment Options
The treatment of overactive bladder typically involves a combination of behavioral modifications and pharmacological interventions.
- Anticholinergics such as oxybutynin, tolterodine, solifenacin, darifenacin, and trospium work by blocking acetylcholine receptors in the bladder muscle, reducing involuntary contractions 1.
- Beta-3 agonists like mirabegron relax the bladder muscle by activating beta-3 receptors, and have been shown to be effective in improving urinary urgency, frequency, and/or urgency urinary incontinence 1.
Recommended Treatment
Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence 1. The body of evidence supporting the use of antimuscarinic medications and beta-3 adrenergic agonist oral medications has demonstrated improvement in urgency urinary episodes, voiding episodes, and UUI as compared to placebo 1.
Considerations
When treating patients with overactive bladder, it is essential to consider the potential side effects of these medications, such as dry mouth, constipation, and blurred vision with anticholinergics, and increased blood pressure with mirabegron 1. Treatment typically begins with lower doses and may be adjusted based on symptom improvement and side effects. These medications are most effective when combined with behavioral modifications like timed voiding, fluid management, and pelvic floor exercises. Patients should take anticholinergics with water and mirabegron consistently with or without food. Treatment duration varies but often continues long-term as overactive bladder is typically a chronic condition requiring ongoing management. In patients with co-existing benign prostatic hyperplasia (BPH) and overactive bladder, monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist may be considered 1.
From the FDA Drug Label
MYRBETRIQ is indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency DETROL LA is a prescription medicine for adults used to treat the following symptoms due to a condition called overactive bladder: • Having a strong need to urinate with leaking or wetting accidents (urge urinary incontinence) • Having a strong need to urinate right away (urgency) • Having to urinate often (frequency)
Medications for Overactive Bladder:
- Mirabegron (MYRBETRIQ) is used to treat overactive bladder in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 2
- Tolterodine (DETROL LA) is used to treat symptoms of overactive bladder, including urge urinary incontinence, urgency, and frequency in adults 3
From the Research
Medications for Overactive Bladder
Medications used to treat overactive bladder (OAB) include:
- Antimuscarinics, such as oxybutynin, tolterodine, solifenacin, darifenacin, trospium, imidafenacin, and fesoterodine 4, 5, 6, 7
- Beta-3 agonists, such as mirabegron and vibegron 4, 8
- Intravesical injection of botulinum toxin A 4, 5
Established Treatments
Established treatments for OAB include:
- Antimuscarinics, which are the mainstay of pharmacotherapy for OAB 5, 6, 7
- Mirabegron, which has been shown to be effective in treating OAB, particularly in severe cases 4, 8
- Intravesical injection of botulinum toxin A, which has been shown to be effective in treating OAB, particularly in patients who have not responded to other treatments 4, 5
Emerging Treatments
Emerging treatments for OAB include:
- Newer antimuscarinics, which have better tolerability and efficacy compared to older antimuscarinics 4, 7
- Targeted secretion inhibitors (TSI), which can increase efficacy and reduce adverse effects 4
- Liposome integrated botulinum toxin A, which has an advantage of effective administration by intravesical instillation 4
- Gene therapy, which appears promising but requires further research 4
Treatment Selection
The choice of treatment for OAB should be guided by individual patient characteristics, such as comorbidities and preferences 5, 8. Antimuscarinics and beta-3 agonists have different pharmacologic properties, dosing schedules, and tolerability profiles, making it essential to individualize treatment for each patient 8, 7.