Should I discontinue Gemtesa (vibegron) in a patient experiencing urinary retention?

Management of Urinary Retention in a Patient on Gemtesa (Vibegron)

Yes, you should discontinue Gemtesa (vibegron) in a patient experiencing difficulty urinating or urinary retention, as this medication may be contributing to the problem. 1

Understanding Gemtesa and Urinary Retention

Gemtesa (vibegron) is a β3-adrenergic receptor agonist used for treating overactive bladder (OAB). While it has a different mechanism of action than antimuscarinic medications, it can still potentially affect bladder function in ways that might contribute to urinary retention:

• Vibegron works by relaxing the detrusor muscle of the bladder, which increases bladder capacity and can potentially lead to difficulty emptying in susceptible individuals 2, 3
• Unlike antimuscarinic agents that have higher rates of dry mouth and constipation, vibegron has a different side effect profile but can still affect urinary function 4, 5

Evaluation Algorithm for Urinary Retention in Patients on OAB Medications

1. Immediately discontinue Gemtesa if the patient is experiencing difficulty urinating or urinary retention 1
2. Measure post-void residual (PVR) to assess the severity of retention 1
3. Obtain urinalysis and urine culture to rule out urinary tract infection as a contributing factor 1
4. Consider urodynamic studies if symptoms persist after medication discontinuation to further evaluate bladder function 1

Management Approach

• Discontinue Gemtesa immediately and monitor for improvement in urinary symptoms 1
• If retention is severe (PVR >200 mL), consider temporary catheterization until bladder function normalizes 1
• Once symptoms resolve, consider alternative treatment options for OAB that have lower risk of urinary retention 1, 4
• If pharmacotherapy is still needed after resolution, consider antimuscarinic agents with lower retention risk, such as solifenacin, which has been shown to have lower discontinuation rates due to adverse effects 1

Alternative Treatment Options After Resolution

• Non-pharmacologic options should be considered first after resolution:

  • Pelvic floor muscle training and bladder training have strong evidence for effectiveness with low risk of adverse effects 1
  • Weight loss and exercise for obese patients can improve OAB symptoms 1

• If pharmacotherapy is necessary, consider:

  • Lower doses of β3-adrenergic agonists (if retention was mild and temporary)
  • Antimuscarinic agents with lower retention risk profiles 1
  • Combination therapy at lower doses of each medication class may be effective with fewer side effects 4

Important Considerations and Pitfalls

• Monitor closely for resolution of urinary retention symptoms after discontinuation of Gemtesa 1
• Avoid restarting the same medication at the same dose if it caused urinary retention 1
• Recognize that elderly patients are at higher risk for urinary retention with medications affecting bladder function 4, 2
• Consider comorbidities that might increase risk of urinary retention (BPH, neurological conditions, pelvic floor disorders) 1
• Document the adverse effect in the patient's record to avoid future re-exposure to the same medication 1

Follow-up Recommendations

• Reassess urinary symptoms within 1-2 weeks after discontinuation 1
• Measure PVR again to confirm resolution of retention 1
• If symptoms persist despite medication discontinuation, further urologic evaluation is warranted 1