From the Guidelines
For a geriatric female patient on Mirabegron (Myrbetriq) 50 mg daily with persistent urinary frequency and urgency, I recommend a comprehensive urological evaluation including urodynamic testing to assess bladder function and rule out detrusor overactivity or other underlying conditions. This approach is supported by the American College of Physicians guideline on nonsurgical management of urinary incontinence in women 1.
Alternative Management Options
Alternative medication options include anticholinergics such as solifenacin (Vesicare) 5-10 mg daily or darifenacin (Enablex) 7.5-15 mg daily, though these require caution in geriatric patients due to potential cognitive side effects 1. Combination therapy with Mirabegron and a low-dose anticholinergic might provide synergistic benefits. Non-pharmacological approaches should be emphasized, including:
- Pelvic floor physical therapy
- Bladder training
- Timed voiding
- Fluid management
These treatments work by modulating neural pathways controlling bladder function or directly affecting detrusor muscle contractility. Ruling out urinary tract infection, bladder stones, or malignancy through urinalysis, culture, and cystoscopy is essential before escalating therapy 1.
Advanced Options for Refractory Cases
For refractory cases, advanced options include:
- Posterior tibial nerve stimulation
- Sacral neuromodulation
- Intravesical Botox injections (100-200 units)
These treatments have been shown to be effective in managing urgency UI and improving quality of life, although they may be associated with adverse effects 1. Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. Patient characteristics, such as age, race, comorbid conditions, or baseline UI, did not affect the outcomes of the various pharmacologic medications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative Management Options
If a geriatric female patient is taking Myrbetriq 50 mg daily for urinary frequency and urgency but is not experiencing effective results, there are several alternative management options to consider:
- Switching to a different medication, such as an antimuscarinic agent, may be effective in reducing symptoms of overactive bladder syndrome, as shown in studies 2, 3, 4
- Combination therapy with solifenacin 5mg plus mirabegron 25 or 50mg may provide an efficacy benefit compared to mirabegron 50mg alone, but with more anticholinergic side effects 3
- Assessing and addressing any underlying anxiety or depression symptoms, as these can be correlated with overactive bladder symptoms, and improving overactive bladder symptoms can help relieve anxiety 5
Additional Tests
Additional tests that may be considered to further evaluate the patient's condition include:
- Urodynamic tests to assess bladder function and identify any underlying issues
- Urinalysis to rule out any underlying urinary tract infections or other conditions that may be contributing to symptoms
- Assessment of the patient's medical history and current medications to identify any potential interactions or underlying conditions that may be affecting treatment efficacy
Considerations
When considering alternative management options, it is essential to take into account the patient's individual needs, medical history, and current medications. The patient's age and potential for adverse effects should also be considered, as older adults may be more susceptible to certain side effects, such as dry mouth and hypertension 6, 4