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If initial efforts for conservative measures don’t reduce or eliminate OAB symptoms there are many medication options which exist.  The most commonly prescribed drugs are a type of anticholinergic medications called antimuscarinics. Additionally, a new class of medications, the B3-adrenoceptor agonists, are now also available.

Classes of Medications

Anticholinergic (Antimuscarinic) Medications

The following drugs are in this category:

Tolterodine (Detrol)
Oxybutynin (Ditropan XL)
Oxybutynin as a skin patch (Oxytrol)
Oxybutynin gel (Gelnique)
Trospium (Sanctura)
Solifenacin (Vesicare)
Darifenacin (Enablex)
Fesoterodine (Toviaz)

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How do these medications work?

Anticholinergics inhibit the binding of acetylcholine to the muscarinic receptors in the detrusor, thereby suppressing involuntary bladder contractions. This results in an increase in bladder volume voided and a decrease in micturition frequency, the sensation of urgency, and the number of urge incontinence episodes. An extended-release form, which you take once a day, might cause fewer side effects than the immediate-release versions, which are usually taken multiple times a day.

These medications are usually given as a pill or tablet that you take by mouth.  Numerous formulations are available ranging from immediate release to extended release and in different strengths of medication.  

It can take several weeks before your symptoms begin to improve on this type of medication. It might take 12 weeks to have the full effect.

For detailed information regarding the safety and efficacy of individual medications click the link below.

Safety warnings

Do not take if you have the following:

  • Urinary retention
  • Delayed or slow emptying of your stomach: Use with extreme caution.
  • Uncontrolled narrow-angle glaucoma:  Do NOT use antimuscarinics in patients with narrow-angle glaucoma unless approved by an ophthalmologist.
  • Allergic to ingredients of the medication.

Tell your doctor if you have any of the following:

  • Liver or kidney disease
  • QT prolongation
  • Pregnant or planning on becoming pregnant
  • Breastfeeding or planning to breastfeed

Side effects

The side effects of the antimuscarinic medications include the following:

  • Constipation
  • Dry eyes
  • Dry mouth
  • Headache
  • Confusion or forgetfulness (particularly in older people with underlying memory issues)
  • Rapid heart rate.

Management of side effects

Medication compliance and success depends not only on the efficacy of medications but also on avoidance or management of side effects.  Below are some suggestions to help manage some of the more common side effects.

Dry Mouth

Your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth. Over-the-counter preparations, such as Biotene products, can be helpful for long-term treatment of dry mouth.

Dry Eyes

Use eyedrops to keep your eyes moist

Constipation

To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.

Beta-3 Adrenergic Agonists

Myrbetriq (Mirabegron)

www.myrbetriq.com

The drug mirabegron (Myrbetriq) is the first in a class of drugs called beta-3 adrenergic agonists. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine. 

Compared to other OAB drugs, this medication stimulates bladder relaxation and should have fewer side effects.

Safety

Do not use Myrbetriq if you have an allergy to mirabegron or any of the ingredients in Myrbetriq.

  • Myrbetriq may cause serious side effects including:
    Increased blood pressure: Myrbetriq may cause your blood pressure to increase or make your blood pressure worse if you have a history of high blood pressure. It is recommended that your doctor check your blood pressure while you are taking Myrbetriq.
  • Inability to empty your bladder (urinary retention): Myrbetriq may increase your chances of not being able to empty your bladder if you have bladder outlet obstruction (BOO), or if you are taking other medications to treat OAB.
  • Angioedema: Myrbetriq may cause an allergic reaction with swelling of the face, lips, throat or tongue, with or without difficulty breathing.

The most common side effects of Myrbetriq include:

  • Increased blood pressure
  • Common cold symptoms (nasopharyngitis)
  • Urinary tract infection
  • Constipation
  • Diarrhea
  • Dizziness
  • Headache

Tell your doctor if you have any side effect that bothers you or that does not go away or if you have swelling of the face, lips, tongue, or throat, hives, skin rash, or itching while taking Myrbetriq. These are not all the possible side effects of Myrbetriq. For more information, ask your doctor or pharmacist.

Management of side effects

Medication compliance and success depends not only on the efficacy of medications but also on avoidance or management of side effects.  Below are some suggestions to help manage some of the more common side effects.

Dry Mouth

Your doctor may recommend that you suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth. Over-the-counter preparations, such as Biotene products, can be helpful for long-term treatment of dry mouth.

Dry Eyes

Use eyedrops to keep your eyes moist

Constipation

To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.

AUA Guidelines for OAB

These are the American Urologic Association (AUA) guidelines for OAB medical treatment:

  • If an immediate release (IR) and an extended-release (ER) formulation are available, then ER formulations should preferentially be prescribed over IR formulations because of lower rates of dry mouth.
  • If a patient experiences inadequate symptom control and/or unacceptable adverse drug events with one antimuscarinic medication, then a dose modification or a different antimuscarinic medication or a β3-adrenoceptor agonist may be tried.
  • Clinicians should not use antimuscarinics in patients with narrow-angle glaucoma unless approved by the treating ophthalmologist and should use antimuscarinics with extreme caution in patients with impaired gastric emptying or a history of urinary retention.
  • Clinicians should manage constipation and dry mouth before abandoning effective antimuscarinic therapy. Management may include bowel management, fluid management, dose modification or alternative antimuscarinics.
  • Clinicians must use caution in prescribing antimuscarinics in patients who are using other medications with anticholinergic properties.
  • Clinicians should use caution in prescribing antimuscarinics or β3-adrenoceptor agonists in the frail OAB patient.
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