From the Guidelines
For a geriatric female on Betmiga (mirabegron) 50 mg daily with persistent urinary frequency and urgency, I recommend a comprehensive reassessment, including consideration of combination therapy with an anticholinergic medication like solifenacin 5 mg daily, as well as non-pharmacological approaches and further diagnostic testing. The American College of Physicians 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.
Diagnostic Considerations
Before adding medication, it is essential to:
- Obtain a post-void residual measurement to rule out urinary retention
- Perform a urinalysis and urine culture to exclude urinary tract infection
- Consider urodynamic testing to distinguish between detrusor overactivity and other conditions like stress incontinence
- Use a bladder diary for 3-7 days to document fluid intake, voiding patterns, and leakage episodes
Treatment Options
Non-pharmacological approaches should be reinforced, including:
- Pelvic floor exercises
- Timed voiding
- Fluid management If symptoms persist despite these measures, referral to a urogynecologist or urologist for cystoscopy and advanced treatment options like botulinum toxin injections or sacral neuromodulation may be necessary 1.
Special Considerations in Geriatric Patients
Medication side effects and polypharmacy must be carefully monitored, with dose adjustments made according to renal function. The choice of pharmacologic agent should be based on the patient's individual characteristics, including age, comorbid conditions, and baseline UI symptoms 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative Tests
- If the patient is experiencing urinary frequency and urgency while on Betrich 50 mg daily, other tests can be considered to determine the underlying cause of the symptoms, such as urinalysis, post-void residual, and urodynamic testing 2.
- A comprehensive history and physical examination can also help identify potential causes of urinary frequency and urgency 2, 3.
- Frequency-volume charts and cystourethroscopy may also be useful in evaluating urinary frequency 3.
Management Options
- Antimuscarinic therapy, such as oxybutynin, tolterodine, trospium chloride, darifenacin, and solifenacin, can be considered for the treatment of overactive bladder symptoms, including urinary frequency and urgency 4.
- However, it is essential to consider the potential for anticholinergic adverse events, such as dry mouth, cognitive impairment, and sleep disturbances, particularly in elderly patients 4.
- Trospium chloride and darifenacin may be safer options for elderly patients, as they are less likely to cause cognitive adverse events and do not negatively affect sleep architecture or quality 4.
- A treatment strategy for urinary frequency in women should involve a high-level plan to address the multifactorial etiology of the symptom, including psychosocial, medical, sexual, urological, gynecologic, endocrine, and pharmacological factors 3.
- Empirical treatment of urinary frequency may be necessary, and it is crucial to listen to the patient and consider the condition in all its aspects, using proven techniques 3.