From the Guidelines
For detrusor overactivity and bladder spasms, solifenacin is considered the most effective antispasmodic medication due to its high efficacy and relatively low risk of discontinuation due to adverse effects, as evidenced by the 2019 AUA/SUFU guideline amendment 1. The choice of antispasmodic medication should be based on individual patient factors, including tolerability, adverse effect profile, ease of use, and cost of medication, as recommended by the American College of Physicians 1. Some key points to consider when selecting an antispasmodic medication include:
- Solifenacin has been shown to have a high efficacy in reducing urinary incontinence episodes and improving symptoms of overactive bladder, with a relatively low risk of discontinuation due to adverse effects 1
- Other effective options include tolterodine, darifenacin, and oxybutynin, which work by blocking muscarinic receptors in the bladder, reducing involuntary contractions that cause spasms and urgency 1
- Lifestyle modifications, such as timed voiding, limiting caffeine and alcohol intake, and pelvic floor exercises, can complement medication therapy and improve symptoms of overactive bladder
- For severe cases unresponsive to oral medications, botulinum toxin (Botox) injections into the bladder wall may be considered, as evidenced by the 2019 AUA/SUFU guideline amendment 1 It's essential to consult with a healthcare provider before starting any medication, as the best choice depends on individual factors like age, other medical conditions, and potential drug interactions. The most recent and highest quality study, the 2019 AUA/SUFU guideline amendment 1, provides the strongest evidence for the use of solifenacin as the most effective antispasmodic medication for detrusor overactivity and bladder spasms.
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.
1.2 Pediatric Neurogenic Detrusor Overactivity (NDO) Mirabegron extended-release tablets are indicated for the treatment of NDO in pediatric patients aged 3 years and older and weighing 35 kg or more.
The most effective antispasmodic medication for detrusor overactivity and bladder spasms is mirabegron. It is indicated for the treatment of overactive bladder (OAB) in adults and neurogenic detrusor overactivity (NDO) in pediatric patients aged 3 years and older and weighing 35 kg or more 2.
Key points:
- Mirabegron is effective in treating OAB and NDO.
- It is indicated for use in adults and pediatric patients aged 3 years and older and weighing 35 kg or more.
- The medication has been shown to improve maximum cystometric (bladder) capacity (MCC) in patients with NDO 2.
From the Research
Antispasmodic Medications for Detrusor Overactivity
The most effective antispasmodic medication for detrusor overactivity and bladder spasms can be determined by examining the available evidence.
- Tolterodine and oxybutynin are commonly used anticholinergic drugs for overactive bladder symptoms 3, 4.
- Solifenacin and fesoterodine are newer agents that have shown efficacy in reducing symptoms of overactive bladder, with solifenacin demonstrating better efficacy than tolterodine in some studies 4, 5.
- Extended-release formulations of oxybutynin and tolterodine have been shown to have less risk of dry mouth compared to immediate-release preparations 3, 4, 6.
- Transdermal formulations of oxybutynin, such as oxybutynin topical gel, have been developed to reduce anticholinergic adverse effects and improve tolerability 7.
Comparison of Antispasmodic Medications
The following comparisons can be made between antispasmodic medications:
- Tolterodine versus oxybutynin: Tolterodine may be preferred for reduced risk of dry mouth 3, 4.
- Solifenacin versus tolterodine: Solifenacin may be preferred for better efficacy and less risk of dry mouth 4.
- Fesoterodine versus extended-release tolterodine: Fesoterodine may be preferred for superior efficacy, but has a higher risk of withdrawal due to adverse events and dry mouth 4.
- Extended-release versus immediate-release preparations: Extended-release preparations may be preferred for less risk of dry mouth 3, 4, 6.