What are the medications for overactive bladder (OAB)?

From the Guidelines

Medications for overactive bladder (OAB) include anticholinergic medications and beta-3 adrenergic agonists, with combination therapy of an anti-muscarinic and β3-adrenoceptor agonist considered for patients refractory to monotherapy. The first-line prescription treatments are anticholinergic medications such as oxybutynin (Ditropan, 5mg 2-3 times daily), tolterodine (Detrol, 2mg twice daily), solifenacin (VESIcare, 5-10mg once daily), darifenacin (Enablex, 7.5-15mg once daily), and trospium (Sanctura, 20mg twice daily) 1. These work by blocking acetylcholine receptors in the bladder muscle, reducing involuntary contractions. Beta-3 adrenergic agonists like mirabegron (Myrbetriq, 25-50mg once daily) are another option that relax the bladder muscle through a different mechanism and may cause fewer dry mouth side effects 1.

Some key points to consider when treating OAB include:

• Common side effects of anticholinergics include dry mouth, constipation, blurred vision, and confusion (especially in older adults) 1
• Treatment typically begins with lower doses and increases if needed
• Lifestyle modifications should accompany medication, including scheduled voiding, limiting caffeine and alcohol, and pelvic floor exercises
• If one medication doesn't work after 4-8 weeks, switching to another class may help
• For severe cases unresponsive to oral medications, bladder Botox injections or nerve stimulation therapy might be considered
• Combination therapy with an anti-muscarinic and β3-adrenoceptor agonist may be considered for patients refractory to monotherapy, with studies such as the SYNERGY I/II and BESIDE trials demonstrating improved efficacy without significant effects on safety profile 1

The most recent and highest quality study, the 2019 AUA/SUFU guideline amendment, recommends considering combination therapy for patients refractory to monotherapy with either anti-muscarinics or β3-adrenoceptor agonists 1. This study provides the strongest evidence for the use of combination therapy in the treatment of OAB, and its recommendations should be prioritized in clinical practice.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.

The medication for overactive bladder (OAB) is mirabegron.

• Indications: Mirabegron is indicated for the treatment of OAB in adult patients with symptoms of:
  • Urge urinary incontinence
  • Urgency
  • Urinary frequency 2

From the Research

Medications for Overactive Bladder (OAB)

The following medications are used to treat OAB:

• Antimuscarinics, which are the mainstay of pharmacologic treatment for OAB 3
• Mirabegron, a first-in-class β3-adrenoceptor agonist licensed for the treatment of OAB 4
• Specific antimuscarinic agents, including:
  • Oxybutynin 5, 3, 6
  • Tolterodine 5, 3, 6
  • Trospium 3, 6
  • Solifenacin 4, 3, 6
  • Darifenacin 4, 3, 6
  • Fesoterodine 4, 6
  • Imidafenacin 6
  • Propiverine 6

Emerging Treatments for OAB

Newer treatments for OAB are being developed, including:

• Newer β3-agonists 7
• Combinations of antimuscarinics, β3-agonists, and antidiuretics 7
• Targeted secretion inhibitors (TSI) 7
• Liposome integrated botulinum toxin A 7
• Gene therapy 7
• Sacral neuromodulation 7
• Intravesical injection of botulinum toxin A 7