What is Myrbetriq (mirabegron) and does it affect sleep?

Myrbetriq (Mirabegron) and Its Effects on Sleep

Myrbetriq (mirabegron) is a β3-adrenoceptor agonist approved for treating overactive bladder syndrome, and recent evidence shows it can improve sleep by reducing nocturia and sleep disturbances associated with lower urinary tract symptoms. 1

What is Myrbetriq (Mirabegron)?

• Mirabegron is the first β3-adrenoceptor agonist approved for treating adults with overactive bladder (OAB) syndrome 2
• It works through a different mechanism of action than antimuscarinic agents, which are the traditional medications for OAB 3
• Mirabegron is available in 25mg and 50mg doses, typically starting at 25mg daily with potential increase to 50mg based on response 4
• It is recognized by both the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) as an effective treatment option for OAB 4

Effects on Sleep

• A prospective, open-label 12-week trial demonstrated that mirabegron significantly improves sleep measures in patients with disordered sleep and lower urinary tract symptoms 1
• Patient-Reported Outcome Measurement Information System Sleep Disturbance scores decreased from 26.5 to 19.3 points, representing an improvement from clinically 'mild' to 'none to slight' sleep disturbance (p < 0.001) 1
• Jenkins Sleep Scale scores also decreased significantly from 14.1 to 8.3 (p < 0.001), indicating improved sleep quality 1
• Mirabegron reduced nighttime voids (nocturia) by 0.8 voids per night (p < 0.05), which helps prevent sleep cycle disruption 1
• By reducing nocturia, mirabegron helps maintain normal sleep cycles, which are critical for overall health and quality of life 1

Efficacy for Overactive Bladder

• Mirabegron significantly reduces micturition frequency, urgency incontinence, and urgency in patients with OAB 3
• Improvements in symptoms are seen as early as 4 weeks after starting treatment and are maintained throughout the treatment period 3
• The medication is effective in both treatment-naïve patients and those who previously discontinued antimuscarinic therapy 3
• Mirabegron is also effective in special populations, including elderly patients (≥65 years) 3, 5
• For patients with inadequate response to mirabegron monotherapy, combination therapy with an antimuscarinic agent (like solifenacin) may provide additional benefits 6, 7

Safety and Tolerability

• Mirabegron has a favorable safety and tolerability profile compared to antimuscarinic medications 3
• The incidence of dry mouth with mirabegron is similar to placebo and three to five times lower than with antimuscarinic drugs like tolterodine 3
• Common adverse events include hypertension, nasopharyngitis, and urinary tract infection 3
• Regular blood pressure monitoring is recommended, especially during the initial treatment period and for patients with pre-existing hypertension 4
• Mirabegron carries a low risk of QT interval prolongation 2
• Caution should be used when prescribing mirabegron in frail patients, though it has demonstrated safety in older patients with multiple comorbidities 6, 7

Clinical Implications

• For patients suffering from sleep disturbances related to nocturia or OAB symptoms, mirabegron offers a dual benefit of improving both urinary symptoms and sleep quality 1
• The medication's favorable side effect profile makes it particularly suitable for patients who cannot tolerate the anticholinergic side effects (like dry mouth and constipation) of traditional OAB medications 3
• For men with lower urinary tract symptoms, regular re-evaluation of symptoms and post-void residual volume is advised 4
• Patients should be advised to discontinue medication if worsening voiding symptoms or urinary stream is noted after initiation of therapy 4

Mirabegron represents an effective treatment option for OAB with the added benefit of improving sleep in patients whose sleep is disrupted by urinary symptoms, particularly nocturia.