What are the medications for detrusor (detrusor muscle) overactivity causing bladder spasms?

From the Guidelines

Medications for bladder spasms should include anticholinergics like solifenacin (5-10mg daily) or beta-3 agonists like mirabegron (25-50mg daily) as first-line treatment, considering their efficacy and tolerability as shown in recent studies 1. When managing bladder spasms, it's essential to consider the patient's overall health, potential side effects, and the severity of their symptoms.

• Anticholinergics such as oxybutynin, tolterodine, and darifenacin can be effective but may have more side effects like dry mouth, constipation, and blurred vision compared to beta-3 agonists 1.
• Beta-3 agonists like mirabegron offer a different mechanism of action with potentially fewer side effects, making them a viable alternative for patients who cannot tolerate anticholinergics 1.
• Combination therapy of solifenacin and mirabegron has shown promise in reducing urinary incontinence episodes and improving symptoms, but it may increase the risk of adverse effects like dry mouth and constipation 1.
• Lifestyle modifications, including timed voiding, limiting caffeine and alcohol, and pelvic floor exercises, should accompany medication to enhance treatment efficacy and improve the patient's quality of life. The choice of medication should be based on the patient's specific needs, the severity of their symptoms, and their ability to tolerate potential side effects, as recommended by recent guidelines 1.

From the FDA Drug Label

Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The medication for bladder spasms is mirabegron.

• 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 2.

From the Research

Medication for Bladder Spasms

• Anticholinergic drugs are commonly used to treat overactive bladder symptoms, including bladder spasms 3.
• Different anticholinergic drugs have varying effects on bladder spasms, with some having better efficacy and fewer side effects than others 3, 4.
• Tolterodine, solifenacin, and fesoterodine are some of the anticholinergic drugs used to treat bladder spasms, with solifenacin and fesoterodine showing better efficacy in some studies 3.
• The choice of anticholinergic drug depends on various factors, including the patient's age, medical history, and the presence of other medical conditions 4, 5.
• Combination therapy with multiple anticholinergic drugs may be effective in treating neurogenic overactive bladder, but may also increase the risk of side effects 6.

Side Effects of Medication

• Anticholinergic drugs can cause side effects such as dry mouth, constipation, and blurred vision 3, 4, 5.
• The risk of side effects increases with the dose of the anticholinergic drug, and some drugs may have a higher risk of side effects than others 5.
• Elderly patients may be more susceptible to the side effects of anticholinergic drugs, particularly cognitive impairment and sleep disturbances 4.

Treatment Approach

• A stepwise approach to treatment is recommended, starting with behavioral therapy and progressing to pharmacologic treatment and other therapies as needed 7.
• Patients should be carefully monitored and counseled on available treatment options to optimize symptom control and set realistic expectations 7.