From the Guidelines
The patient should be started on Myrbetriq (mirabegron) to address her overactive bladder symptoms, with close monitoring of her blood pressure due to her existing hypertension, as recommended by the American College of Physicians 1. The patient is a 79-year-old female with urinary symptoms including frequency, nocturia 2-5 times per night, and occasional urgency and urge incontinence for the past year. After evaluation, including pelvic and renal ultrasounds showing normal bladder walls and kidneys (with incidental findings of a small right kidney angiomyolipoma and left kidney vascular calcification), Myrbetriq (mirabegron) was prescribed to address her overactive bladder symptoms. Myrbetriq works by relaxing the bladder muscle during filling, which helps increase bladder capacity and reduce symptoms of urgency, frequency, and urge incontinence. This medication is appropriate for her presentation as she has no signs of urinary tract infection (pending UA/UCx results) and her symptoms are consistent with overactive bladder syndrome. Some key points to consider in her management include:
- Monitoring for potential side effects of Myrbetriq, which may include increased blood pressure, headache, nasopharyngitis, and urinary tract infection 1.
- Given her existing hypertension, blood pressure monitoring is particularly important, and her treatment plan should be guided by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.
- Lifestyle modifications such as timed voiding, fluid management, and pelvic floor exercises could also complement the medication therapy, as nonpharmacologic therapies have been shown to be effective in managing urinary incontinence in women 1. It is also important to note that the patient's age and comorbidities, including her hypertension, should be taken into consideration when managing her overactive bladder symptoms, and that she should be closely monitored for any potential adverse effects of her medication.
From the FDA Drug Label
14 CLINICAL STUDIES
- 1 Mirabegron Monotherapy for Adult OAB Mirabegron was evaluated in three, 12-week, double-blind, randomized, placebo-controlled, parallel group, multicenter clinical trials in patients with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency (Studies 1,2, and 3) Entry criteria required that patients had symptoms of overactive bladder for at least 3 months duration, at least 8 micturitions per day, and at least 3 episodes of urgency with or without incontinence over a 3-day period. The co-primary efficacy endpoints in all 3 trials were (1) change from baseline to end of treatment (Week 12) in mean number of incontinence episodes per 24 hours and (2) change from baseline to end of treatment (Week 12) in mean number of micturitions per 24 hours, based on a 3-day micturition diary An important secondary endpoint was the change from baseline to end of treatment (Week 12) in mean volume voided per micturition.
The patient's symptoms of urinary frequency, nocturia, urgency, and urge incontinence are consistent with overactive bladder (OAB).
- The mirabegron drug label 2 indicates that mirabegron is effective in treating the symptoms of OAB, including incontinence episodes, micturition frequency, and volume voided per micturition.
- The studies showed that mirabegron 25 mg and 50 mg were effective in treating OAB symptoms within 8 weeks and 4 weeks, respectively, and maintained efficacy through the 12-week treatment period.
- Given the patient's symptoms and the efficacy of mirabegron in treating OAB, mirabegron may be a suitable treatment option for this patient.
From the Research
Patient Presentation and History
- The patient is a 79-year-old female presenting with complaints of urinary frequency, nocturia, occasional urgency, and urge incontinence for the past year.
- She has a history of smoking and hypertension, but denies family history of urologic disorders, caffeinated drinks consumption, dysuria, hematuria, and fever.
- Her past medical history includes hypertension, and she has undergone surgery for fibroma removal.
Medications and Treatment Options
- The patient is currently taking several medications, including Trazodone, Magnesium gluconate, Aspirin, Amantadine, Austedo, Clonidine, Zolpidem, Loratadine, Atorvastatin, Metoprolol, and Hydralazine.
- The patient has been prescribed Myrbetriq (mirabegron) to help relieve her symptoms of overactive bladder, as discussed with her and considering her medical history and current medications.
Efficacy and Safety of Mirabegron
- Studies have shown that mirabegron is effective in treating symptoms of overactive bladder, including micturition frequency, urgency incontinence, and urgency 3, 4, 5, 6.
- Mirabegron has been found to be well-tolerated, with a favorable safety profile compared to antimuscarinics, particularly in terms of dry mouth, constipation, and CNS effects 3, 4, 7, 5, 6.
- The incidence of cardiovascular adverse events with mirabegron is comparable to placebo, and mirabegron does not appear to confer increased risk of cardiovascular adverse events 7.