From the Guidelines
If Myrbetriq (mirabegron) 50mg daily is not effective in controlling urinary frequency and urgency symptoms, the most appropriate alternative is to increase the dose to 75mg daily or consider combination treatment with an a1-blocker, as recommended by the 2023 European Association of Urology guidelines 1. When considering treatment options for male lower urinary tract symptoms (LUTS), it's essential to prioritize the management of bladder storage symptoms, such as frequency and urgency. The guidelines suggest using beta-3 agonists, like mirabegron, in men with moderate-to-severe LUTS who mainly have bladder storage symptoms 1. Some key points to consider when managing LUTS include:
- Offering lifestyle advice and self-care information prior to, or concurrent with, treatment 1
- Using a1-blockers to men with moderate-to-severe LUTS 1
- Considering combination treatment with an a1-blocker and a 5-ARI to men with moderate-to-severe LUTS and an increased risk of disease progression 1
- Informing the patient that the magnitude of efficacy may be modest 1 It's crucial to discuss persistent symptoms with a healthcare provider to rule out other causes like urinary tract infection or incomplete bladder emptying. The difference in mechanism of action between mirabegron and other medication classes, such as anticholinergics, explains why some patients respond better to one medication class than another, or benefit from combination therapy. Side effects of increased mirabegron dosage may include higher blood pressure, while anticholinergics typically cause dry mouth, constipation, and blurry vision. According to the 2019 AUA/SUFU guideline amendment, symptoms of both daytime and nighttime urinary frequency and urgency (with or without urgency incontinence) are self-reported as bothersome, and the patient may be diagnosed with overactive bladder (OAB) 1.
From the FDA Drug Label
2.2 Recommended Dosage for Adult Patients with OAB Mirabegron Monotherapy The recommended starting dosage of mirabegron extended-release tablets is 25 mg orally once daily. If needed, increase to the maximum dosage of mirabegron extended-release tablets 50 mg orally once daily after 4 to 8 weeks.
The maximum dose of mirabegron is 50 mg orally once daily. Since you are already taking Mybetriq 50mg daily and it is not effective, the dose cannot be increased further. Alternative treatments should be considered. 2
From the Research
Alternative Treatment Options
If Myrbetriq 50mg daily is not effective in managing overactive bladder symptoms, such as frequency and urgency, there are alternative treatment options to consider:
- Increasing the dose of Myrbetriq to 100mg daily, as studies have shown that higher doses can be effective in reducing symptoms of overactive bladder 3, 4
- Switching to a different medication, such as an antimuscarinic agent, which can help to relax the bladder muscle and reduce symptoms of overactive bladder 5, 6
- Combining Myrbetriq with an antimuscarinic agent, which may provide additional symptom relief 4
Dose Adjustment
When considering a dose adjustment, it is essential to weigh the potential benefits against the potential risks:
- Increasing the dose of Myrbetriq to 100mg daily may be associated with a higher risk of adverse effects, such as hypertension and dry mouth 3, 4
- However, studies have shown that Myrbetriq is generally well-tolerated, and the incidence of dry mouth is similar to that of placebo 6, 3
Considerations for Treatment
When selecting an alternative treatment option, consider the following factors:
- Efficacy: Myrbetriq has been shown to be effective in reducing symptoms of overactive bladder, including frequency and urgency 5, 6, 3, 4, 7
- Safety: Myrbetriq has a favorable safety profile, with a low risk of adverse effects such as dry mouth and constipation 6, 3, 4
- Tolerability: Myrbetriq is generally well-tolerated, and the incidence of adverse effects is similar to that of placebo 6, 3