What is the recommended adult dose of flavoxate (Flovaxota) for treating urinary frequency or over‑active bladder?

Flavoxate (Flovaxota) Adult Dosing for Overactive Bladder

The recommended adult dose of flavoxate is 200 mg three times daily (600 mg/day), with the option to increase to 200 mg four times daily (800 mg/day) for enhanced efficacy, particularly in refractory cases. 1, 2

Standard Dosing Regimen

• Start with 200 mg orally three times daily (600 mg/day total) for initial management of urinary frequency, urgency, and urge incontinence 1
• Treatment duration should be at least 2-4 weeks to adequately assess therapeutic response 1, 3

Dose Optimization

• Consider increasing to 200 mg four times daily (800 mg/day total) if symptoms persist or for patients requiring more robust symptom control 2
• Clinical data demonstrates that 800 mg/day produces superior results compared to 600 mg/day, with better reduction in dysuria (37%), nocturia (53%), daytime urge (61%), and nighttime urge (69%) 2
• The higher dose (800 mg/day) maintains excellent tolerability with no increase in adverse effects 2

Higher Dose for Refractory Cases

• For patients refractory to standard anticholinergic therapy, doses up to 1200 mg/day (200 mg six times daily) may be used 1, 3
• The 1200 mg/day regimen achieved complete cure in 82% of refractory patients with no reported side effects 1
• Urodynamic studies confirm that 1200 mg/day is significantly superior to 600 mg/day in suppressing uninhibited detrusor contractions, though clinical symptoms improve equally 3

Safety Profile

• Flavoxate demonstrates exceptional tolerability with adverse events occurring in only 1.3-1.8% of patients across multiple studies 1, 2
• The medication does not increase post-void residual urine volume, making it safer than anticholinergics in patients at risk for urinary retention 1, 2
• Side effects are minimal even at the highest doses (1200 mg/day), with discontinuation rates of only 0.6% 1

Clinical Context

While flavoxate is not mentioned in the 2012 AUA/SUFU guidelines for overactive bladder management 4, it represents a well-established alternative with a superior safety profile compared to standard antimuscarinics. The AUA/SUFU guidelines recommend oral antimuscarinics (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium) as second-line therapy after behavioral interventions 4, but flavoxate's minimal anticholinergic activity and excellent tolerability make it a reasonable option, particularly for patients who cannot tolerate standard antimuscarinics 5, 6.

Practical Algorithm

1. Initiate 200 mg three times daily (600 mg/day) for all patients with urinary frequency and urgency 1
2. Assess response at 2-4 weeks - if partial response, increase to 200 mg four times daily (800 mg/day) 2
3. For refractory cases or severe symptoms, consider 1200 mg/day divided into six doses 1, 3
4. Monitor for efficacy by tracking frequency, urgency episodes, nocturia, and bladder volume at first urge sensation 2

Key Advantages Over Antimuscarinics

• Significantly lower incidence of dry mouth, constipation, and cognitive impairment compared to traditional antimuscarinics 5, 6
• No increase in post-void residual volume, reducing retention risk 1, 2
• Effective in 77.4% of patients who failed previous anticholinergic therapy 1