What medication is used to treat bladder spasms?

Medications for Bladder Spasms

Antimuscarinic medications, particularly oxybutynin, are the first-line treatment for bladder spasms at a dose of 0.2 mg/kg orally given three times daily. 1

First-Line Treatment Options

• Oxybutynin is indicated for treatment of detrusor overactivity in patients with neurogenic bladder and is the standard first-line medication for bladder spasms 1
• Tolterodine is an effective alternative with fewer side effects compared to oxybutynin, particularly a lower risk of dry mouth 2, 3
• Solifenacin has shown superior efficacy compared to tolterodine for treating overactive bladder symptoms and may have a lower risk of dry mouth 4, 2

Dosing Considerations

• Standard oxybutynin dosing is 0.2 mg/kg orally three times daily for neurogenic bladder 1
• In clinical practice, most patients are prescribed 5-10 mg/day of extended-release oxybutynin, with only 14.9% requiring dose escalation 5
• Tolterodine is typically administered at 2 mg twice daily, though 1 mg twice daily might be equally effective with less risk of dry mouth 2
• Solifenacin's recommended starting dose is 5 mg once daily, which can be increased to 10 mg for better efficacy but with increased risk of dry mouth 2

Medication Selection Algorithm

1. First choice: Oxybutynin (standard first-line therapy) 1

   • Immediate release: 0.2 mg/kg three times daily
   • Extended release: 5-10 mg once daily

2. If oxybutynin causes intolerable side effects: Switch to tolterodine 2

   • 2 mg twice daily (standard dose)
   • Consider 1 mg twice daily if concerned about dry mouth

3. For patients with inadequate response to tolterodine: Consider solifenacin 4, 2

   • 5 mg once daily, may increase to 10 mg if needed

Special Considerations

• Extended-release formulations of antimuscarinic medications generally have less risk of dry mouth compared to immediate-release preparations 2
• Trospium chloride is an alternative antimuscarinic that works by antagonizing the effect of acetylcholine on muscarinic receptors in the bladder, reducing smooth muscle tonus 6
• For severe, refractory bladder spasms in patients with malignancy, lumbar sympathetic blockade at L4 may be considered 7
• In spinal cord injury patients with severe bladder spasms, intrathecal baclofen may be effective when other treatments fail 8

Common Side Effects and Management

• Dry mouth is the most common side effect of antimuscarinic medications, with oxybutynin having the highest risk and solifenacin having a lower risk 2
• Other common side effects include constipation and blurred vision 1
• If side effects are intolerable, consider:
  1. Reducing the dose
  2. Switching to an extended-release formulation
  3. Changing to a different antimuscarinic with a better side effect profile

Monitoring and Follow-up

• Assess response to treatment by monitoring frequency and severity of bladder spasms
• Evaluate for side effects at each follow-up visit
• Consider dose adjustments based on efficacy and tolerability 5
• For patients with neurogenic bladder, urodynamic studies may be needed to assess treatment effectiveness 1