From the Guidelines
The main medications for overactive bladder besides mirabegron (Myrbetriq) include antimuscarinic medications such as oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, and trospium chloride, as well as beta-3 adrenergic agonists. These medications work by either blocking acetylcholine receptors in the bladder muscle, reducing involuntary contractions, or relaxing the bladder muscle during filling. According to the most recent guideline 1, clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence. The evidence supporting the use of antimuscarinic medications and beta-3 adrenergic agonist oral medications has demonstrated improvement in urgency urinary episodes, voiding episodes, and UUI as compared to placebo 1.
Some key points to consider when prescribing these medications include:
- Typical dosing varies by medication: oxybutynin 5-10mg 2-3 times daily, tolterodine 2-4mg daily, and solifenacin 5-10mg daily
- Common side effects of anticholinergics include dry mouth, constipation, and blurred vision
- Beta-3 adrenergic agonists like mirabegron may cause hypertension
- These medications should be used cautiously in elderly patients and those with certain conditions like glaucoma, urinary retention, or severe constipation
- Lifestyle modifications such as bladder training, pelvic floor exercises, and fluid management should accompany medication therapy for optimal results
It's also important to note that clinicians may consider pharmacologic interventions among patients with predominant OAB symptoms and who happen to have BPH, such as antimuscarinics, b3 agonists, alpha adrenergic antagonists, 5-alpha-reductase inhibitors, and phosphodiesterase-5 inhibitors 1. However, the most recent and highest quality study 1 recommends offering antimuscarinic medications or beta-3 agonists to patients with OAB, making this the preferred treatment option.
From the Research
Main Medications for Overactive Bladder (OAB)
The main medications used to treat overactive bladder (OAB), besides Myrbetriq (mirabegron), are:
- Antimuscarinics, which include:
- Beta-3 agonists, which include:
- Vibegron 5
Efficacy and Tolerability
These medications have been shown to be effective in reducing OAB symptoms, such as:
- Micturition frequency 2, 6
- Incontinence 2, 6
- Urgency urinary incontinence (UUI) episodes 2, 6 However, they may have different tolerability profiles, with antimuscarinics commonly causing:
- Dry mouth 2, 6, 3, 4
- Constipation 2, 6, 3, 4
- Blurred vision 3, 4
Individualized Treatment
It is essential to individualize the medical treatment for each patient's characteristics and expectations 5, as each drug has specific pharmacologic properties, dosing schedule, and tolerability profile.