Gemtesa (Vibegron) Treatment Regimen for Overactive Bladder
The recommended treatment regimen for overactive bladder using Gemtesa (vibegron) is one 75 mg tablet taken orally once daily, with or without food. 1
First-Line Treatment Approach
Before initiating Gemtesa:
- Behavioral therapies should be offered as first-line treatment for all OAB patients 2, 3
- Bladder training with scheduled voiding
- Pelvic floor muscle training
- Fluid management (25% reduction in fluid intake can reduce frequency and urgency)
- Weight loss (for obese patients)
- Caffeine reduction
Pharmacologic Treatment with Gemtesa
When behavioral therapies are insufficient:
- Dosage: 75 mg tablet once daily 1
- Administration:
- Can be taken with or without food
- Swallow tablet whole with a glass of water
- May be crushed and mixed with a tablespoon of applesauce if needed 1
Advantages of Gemtesa Over Antimuscarinic Medications
- Beta-3 adrenergic agonists like vibegron are preferred over antimuscarinics due to:
Efficacy of Gemtesa
Vibegron has demonstrated significant improvements in:
- Urge urinary incontinence episodes 6, 5
- Daily micturition frequency 6, 5
- Urgency episodes 6, 7
- Voided volume 5
These improvements are seen as early as 2 weeks after starting treatment and are sustained throughout treatment 5.
Monitoring and Safety Considerations
- Monitor for signs of urinary retention, particularly in patients with:
- Bladder outlet obstruction
- Patients taking muscarinic antagonists for OAB 1
- Discontinue Gemtesa if urinary retention develops 1
- Watch for hypersensitivity reactions, including angioedema 1
- Efficacy should be assessed at regular intervals to determine continued need for therapy
Combination Therapy Options
For patients with inadequate response to Gemtesa monotherapy:
- Consider combining with behavioral therapies if not already implemented 2, 3
- Combination with antimuscarinic medications may be considered for refractory cases, but monitor closely for increased side effects 2
Special Populations
- Effective and safe in patients ≥65 years of age 4
- Beneficial for patients with polypharmacy due to minimal drug interactions 4
- Effective in both OAB-dry (without incontinence) and OAB-wet (with incontinence) populations 7
Common Pitfalls to Avoid
- Skipping behavioral therapy before or during pharmacologic treatment 3
- Failing to monitor for urinary retention, especially in at-risk patients 1
- Using antimuscarinics as first-line pharmacologic therapy, especially in older adults 2, 3
- Introducing multiple therapies simultaneously instead of using a stepwise approach 2, 3
Gemtesa represents an effective second-line treatment option for OAB with a favorable safety profile compared to traditional antimuscarinic medications.