Gemtesa (Vibegron) Treatment for Overactive Bladder
The recommended dosage of Gemtesa (vibegron) for overactive bladder is one 75 mg tablet taken orally, once daily with or without food. 1
Treatment Algorithm for Overactive Bladder
First-Line Therapy
- Begin with behavioral therapies for all patients with overactive bladder, including bladder training, delayed voiding, pelvic floor muscle training, fluid management, and weight loss 2, 3
- These behavioral interventions are as effective as antimuscarinic medications in reducing OAB symptoms 3
Second-Line Therapy
- When behavioral therapies are insufficient, add pharmacotherapy with Gemtesa (vibegron) 75 mg once daily 2, 1
- Vibegron tablets should be swallowed whole with a glass of water, though they may also be crushed and mixed with a tablespoon of applesauce if needed 1
- Beta-3 agonists like vibegron are typically preferred before antimuscarinic medications due to their favorable side effect profile 2, 3
Indications
- Gemtesa is FDA-approved for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency in adults 1
- It is also indicated specifically for adult males with benign prostatic hyperplasia (BPH) who are on pharmacological therapy for BPH 1
Mechanism and Benefits
- Vibegron is a beta-3 adrenergic receptor agonist that represents an alternative to antimuscarinic medications 2
- It is highly selective for beta-3 receptors and does not interact with cytochrome P450 enzymes, making it advantageous for patients on multiple medications 4
- Clinical trials have shown significant improvements in micturition frequency, urge urinary incontinence episodes, and urgency episodes compared to placebo 5, 6
Special Considerations and Warnings
Elderly Patients
- Vibegron is particularly beneficial for elderly patients (≥65 years) as it does not have the same risk profile for cognitive impairment or dementia as antimuscarinic medications 2, 3
- Efficacy and safety have been demonstrated in patients aged ≥65 and ≥75 years, with significant improvements in OAB symptoms and low rates of cardiovascular adverse events 7
Safety Warnings
- Monitor for signs and symptoms of urinary retention, particularly in patients with bladder outlet obstruction or those taking muscarinic antagonist medications 1
- Gemtesa is contraindicated in patients with known hypersensitivity to vibegron or any components of the medication 1
- Angioedema of the face and/or larynx has been reported with Gemtesa and may be life-threatening; discontinue immediately if this occurs 1
Combination Therapy
- For patients with inadequate response to monotherapy, combination therapy with behavioral therapy and pharmacotherapy may be considered 2
- Combination of a beta-3 agonist with an antimuscarinic medication may also be considered for refractory cases 2
Common Pitfalls to Avoid
- Failing to optimize behavioral therapies before starting medications 3
- Not considering cognitive risks when prescribing antimuscarinics, especially in elderly patients 3
- Using antimuscarinics in patients with contraindications such as narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 3