From the Guidelines
Alternatives to Mirabegron for Overactive Bladder
For patients who are unable to tolerate or have contraindications to mirabegron, alternative treatments for overactive bladder include antimuscarinic agents such as oxybutynin (5-10mg orally twice daily) or tolterodine (2-4mg orally twice daily) 1. Additionally, solifenacin (5-10mg orally once daily) or trospium (20mg orally twice daily) may be considered 1. In some cases, beta-3 adrenergic agonists like vibegron (75mg orally once daily) may also be used as an alternative to mirabegron.
- Key Considerations: When selecting an alternative treatment, it is essential to consider the patient's medical history, potential side effects, and the severity of their overactive bladder symptoms 1.
- Treatment Options: The choice of treatment may involve a combination of lifestyle modifications, behavioral therapies, and pharmacological interventions 1.
- Specialized Management: Patients who are refractory to initial treatments may require evaluation by a specialist and consideration of advanced therapies such as botulinum toxin or sacral neuromodulation 1.
From the Research
Alternatives to Mirabegron for Overactive Bladder
Alternatives to mirabegron for the treatment of overactive bladder (OAB) include antimuscarinic agents, such as tolterodine extended release (ER) 4 mg, solifenacin, and fesoterodine. These agents have a different mechanism of action compared to mirabegron, a β3-adrenoceptor agonist, and may be considered for patients who are intolerant of or have contraindications to mirabegron 2.
Efficacy of Alternatives
- Antimuscarinic agents, such as tolterodine ER 4 mg, have been shown to be effective in reducing the symptoms of OAB, including incontinence episodes and micturitions per 24 hours 3, 4.
- However, antimuscarinic agents may be associated with side effects, such as dry mouth and constipation, which can lead to poor persistence and contribute to anticholinergic burden, particularly in older patients 5.
- Mirabegron has been shown to be effective in treating OAB symptoms, including in patients who have discontinued prior antimuscarinic therapy due to insufficient efficacy or poor tolerability 3, 4.
Tolerability of Alternatives
- Antimuscarinic agents, such as tolterodine ER 4 mg, have been associated with a higher incidence of anticholinergic adverse events, including dry mouth and constipation, compared to mirabegron 5.
- Mirabegron has been shown to have a more favorable tolerability profile, with a lower incidence of dry mouth and central nervous system effects, making it a potential alternative to antimuscarinics for older patients 5, 6.
- The incidence of adverse events, such as hypertension, nasopharyngitis, and urinary tract infection, was similar between mirabegron and placebo in clinical trials 6.
Considerations for Treatment
- The choice of treatment for OAB should be individualized, taking into account the patient's medical history, comorbidities, and potential side effects of treatment 2, 5.
- Mirabegron may be considered as an alternative to antimuscarinics for patients who are intolerant of or have contraindications to these agents, particularly in older patients 5, 6.