From the Guidelines
If Myrbetriq (mirabegron) 50mg daily is not effectively managing your urinary frequency and urgency, the most effective alternative is to increase the dose to 75mg daily or consider combination therapy with an anticholinergic medication, such as solifenacin, as evidenced by the BESIDE trial 1. This approach is supported by the American College of Physicians guideline, which recommends pharmacologic treatment in women with urgency UI if bladder training was unsuccessful, with the choice of pharmacologic agents based on tolerability, adverse effect profile, ease of use, and cost of medication 1. Some key points to consider include:
- Increasing the dose of Myrbetriq to 75mg daily, which is the maximum FDA-approved dose for mirabegron
- Switching to a different medication class, such as anticholinergics (like oxybutynin, solifenacin, or tolterodine), which work through a different mechanism to reduce bladder contractions
- Combination therapy using Myrbetriq with an anticholinergic medication, which has been shown to be effective in reducing urinary incontinence episodes and micturitions per 24 hours 1
- Non-medication options, such as pelvic floor physical therapy, bladder training exercises, and avoiding bladder irritants like caffeine, alcohol, and spicy foods
- Ruling out urinary tract infections or other conditions that might be causing persistent symptoms, as recommended by the AUA/SUFU guideline amendment 2019 1 It's essential to consult with your healthcare provider before changing your medication regimen to ensure safety and appropriate management of your condition, as recommended by the American College of Physicians guideline 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 recommended dose of mirabegron is 50 mg orally once daily. Since you are already taking 50 mg daily and it is not effective, the dose cannot be increased further.
- Alternative treatments may be considered.
- Consult a healthcare professional to discuss other treatment options. 2
From the Research
Alternative Treatment Options
If Mybetriq 50mg daily is not effective in treating overactive bladder symptoms, such as frequency and urgency in females, alternative treatment options can be considered.
- Mirabegron, a β3-adrenoceptor agonist, has been established as an alternative monotherapy to antimuscarinics for the treatment of overactive bladder (OAB) symptoms 3.
- Studies have shown that mirabegron has a favorable safety and tolerability profile, particularly compared with antimuscarinics, for dry mouth, constipation, and many CNS effects 3, 4, 5.
Dose Increase
Regarding the dose of Mybetriq (mirabegron), it can be increased to 100mg daily, as studies have demonstrated significant efficacy in treating OAB symptoms at this dose 4.
- However, it is essential to weigh the potential benefits and risks of increasing the dose, as well as considering alternative treatment options.
Combination Therapy
Combination therapy with mirabegron and an antimuscarinic, such as solifenacin, has been shown to be effective in treating OAB symptoms, particularly in patients with moderate-to-severe symptoms 5, 6.
- This combination therapy has been found to be well-tolerated, with a similar incidence of adverse events compared to monotherapy 6.