From the Guidelines
Mirabegron (brand name Myrbetriq) is indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency. The typical starting dose is 25 mg once daily, which can be increased to 50 mg once daily based on individual response and tolerability 1. Mirabegron works by relaxing the detrusor smooth muscle during the storage phase of the urinary bladder fill-void cycle by activating beta-3 adrenergic receptors, which increases bladder capacity. This mechanism differs from anticholinergic medications, making it a good option for patients who cannot tolerate anticholinergic side effects like dry mouth and constipation.
Key Points to Consider
- Patients should take the medication with water and swallow the tablet whole.
- It can be taken with or without food.
- Common side effects include hypertension, nasopharyngitis, urinary tract infection, and headache.
- Blood pressure should be monitored, especially in patients with hypertension.
- Mirabegron should be used with caution in patients with severe uncontrolled hypertension or significant bladder outlet obstruction.
Clinical Evidence
The efficacy and safety of mirabegron have been evaluated in several clinical trials, including the BESIDE trial, which compared the combination of solifenacin and mirabegron with monotherapy in patients with OAB 1. The results showed that the combination therapy was superior to monotherapy in reducing urinary incontinence episodes and improving quality of life. Additionally, the SYNERGY II trial evaluated the safety and efficacy of combination therapy with solifenacin and mirabegron over 12 months and found that it was statistically superior to monotherapy in reducing incontinence episodes and micturitions per 24 hours 1.
Guideline Recommendations
The American College of Physicians recommends pharmacologic treatment, including mirabegron, for women with urgency urinary incontinence who have not responded to bladder training or pelvic floor muscle training 1. The European Association of Urology also recommends mirabegron as a treatment option for OAB, particularly for patients who cannot tolerate anticholinergic side effects 1.
Conclusion is not allowed, so the answer ends here.
From the FDA Drug Label
Mirabegron extended-release tablets are a beta-3 adrenergic agonist indicated for the treatment of: Overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. Neurogenic detrusor overactivity (NDO) in pediatric patients aged 3 years and older and weighing 35 kg or more.
The indications for Myrbetriq (mirabegron) are:
- Overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- Neurogenic detrusor overactivity (NDO) in pediatric patients aged 3 years and older and weighing 35 kg or more 2, 2, 2.
From the Research
Indications for Myrbetriq (Mirabegron)
- Myrbetriq (mirabegron) is indicated for the symptomatic treatment of adults with overactive bladder syndrome 3, 4, 5, 6, 7
- The symptoms of overactive bladder syndrome include:
- Urinary urgency
- Frequency
- Nocturia
- Urge urinary incontinence
- Mirabegron is approved for the treatment of urgency, urinary frequency, and urge urinary incontinence associated with overactive bladder 7
- It is also used to improve symptoms associated with overactive bladder by enhancing storage function and relaxing the urinary bladder 7
Patient Population
- Mirabegron is effective in treatment-naïve patients and patients who have discontinued prior antimuscarinic therapy due to insufficient efficacy or poor tolerability 5
- It is also effective in patients ≥65 years of age 6
- Mirabegron may be an alternative in patients with overactive bladder who are poor responders to antimuscarinic agents or intolerant of their adverse effects 7