MEDICAL

MANAGEMENT OF
OVERACTIVE BLADDER
ANTIMUSCARINIC AGENTS
• Inhibit muscarinic receptors which mediate
bladder contractions (M2 & M3 )
• Non-selective vs selective; efficacy – 50-75%
• SE – Dry mouth, dyspepsia, constipation, blurred
vision, urinary retention, cognitive/memory
impairment, arrythmias
ANTIMUSCARINIC AGENTS
•Contraindications – Myasthenia gravis,
uncontrolled narrow-angle glaucoma,
significant BOO, GI Obstruction/atony
•Trospium – ↓ BBB penetration;
transdermal oxybutynin patch*
ANTIMUSCARINIC AGENTS
Β3- AGONISTS
• Activates β- receptor in the bladder, leading to
bladder relaxation
• Mirabegron - 50mg (25mg in hepatic/renal
impairment)
• SE – Tachycardia, UTI, palpitations, AF, HTN
• Contraindications – Hypersensitivity, Severe
uncontrolled HTN (SBP >180; DBP >110 mmHg)
• Vibegron (FDA-approved 2020, EMPOWUR
trial) - comparable efficacy, no BBB
penetration
• Combination of anti-muscarinics with β-
agonists more effective (SYNERGY &
SYMPHONY trials, using mirabegron +
solifenacin)