Mirabegron (Myrbetriq) in the Inpatient Setting
Mirabegron (Myrbetriq) should be discontinued during inpatient hospitalization as it is not recommended for routine in-hospital use due to safety concerns and lack of established efficacy in the acute care setting. 1
Rationale for Discontinuation
Current diabetes care and hospital management guidelines recommend that non-insulin glucose-lowering medications, including all classes of non-insulin agents, should generally be discontinued during hospitalization due to safety concerns and limited flexibility for dose adjustments in acute settings 1
Hospital settings frequently involve rapid changes in patient status, procedures, and nutritional intake that require medications with greater flexibility for titration, which mirabegron does not provide 1
The safety and efficacy of non-insulin medications, including agents like mirabegron, have not been well established in the inpatient setting, making insulin the preferred agent for managing patients with hyperglycemia in hospitals 1
Specific Concerns in the Inpatient Setting
Hospitalized patients often experience acute changes in health status that may alter medication metabolism and efficacy, requiring medications that can be rapidly adjusted 1
Inpatient settings frequently involve procedures, fasting states, and altered nutritional intake that may affect medication efficacy and safety profiles 1
Patients may have reduced oral intake or be NPO (nothing by mouth) during hospitalization, which can affect the pharmacokinetics of oral medications like mirabegron 1
Alternatives During Hospitalization
For patients requiring glycemic control in the hospital, insulin therapy is the preferred treatment for the majority of hyperglycemic patients in the hospital setting due to its flexibility and ability to be titrated 1
Basal insulin or a basal plus bolus correction insulin plan is the preferred treatment for noncritically ill hospitalized individuals with poor oral intake or those who are taking nothing by mouth 1
An insulin regimen with basal, prandial, and correction components is the preferred treatment for most noncritically ill hospitalized individuals with adequate nutritional intake 1
Resumption After Discharge
If mirabegron is to be reinstated after discharge, there should be a protocol for guiding resumption of home medications 1–2 days prior to discharge 1
Studies show that many patients who discontinue mirabegron treatment often need to restart it due to symptom recurrence, with one study showing 69% of patients restarting therapy within approximately 48 days 2
When restarting mirabegron after discharge, patients should be monitored for symptom control, as studies indicate significant worsening of overactive bladder symptoms occurs relatively quickly after discontinuation 2, 3
Special Considerations
For patients with overactive bladder, temporary discontinuation of mirabegron during hospitalization is unlikely to cause immediate severe symptoms, but symptoms may gradually return 2, 3
If the patient is hospitalized for a prolonged period, the healthcare team should assess the need for alternative management strategies for overactive bladder symptoms 3
Documentation of the plan to restart mirabegron upon discharge should be included in the discharge planning to ensure continuity of care 1