Drug treatment for overactive bladder

This page contains essential information about drug therapy with an antimuscarinic or with a beta-3 agonist (β3-agonist) for overactive bladder (OAB). It also contains an animation that shows how these drugs work in your body and what side effects you may experience as well as answers to the most frequently asked questions.

Drug therapy with antimuscarinics

Antimuscarinics or Muscarinic receptor antagonists (MRAs) are a group of drugs which reduce the abnormal contractions of the bladder and improve urgency symptoms.

MRAs work similarly, but they may have different side effects and be more or less tolerated by patients. Some MRAs target receptors more selectively than others. The release of the drug into the blood can be quick or can take more time. Side effects tend to be more likely with MRAs that release quickly.

The choice of MRA depends on:

  • Your medical history
  • Other medications you are taking
  • Drugs available in your country
  • Your personal preferences and values

Taking antimuscarinics

Most antimuscarinics are taken by mouth once daily with or without food. The recommended dose for adults differs by the type of MRA. Start with the minimum dosage that gives you the beneficial effects of the drug with as few side effects as possible.

For women who have gone through menopause, the combined use of antimuscarinic and vaginal oestrogen therapy can help reduce the urgent need to urinate and related incontinence.

Antimuscarinics are not recommended for patients who are older than 65 or patinents who suffer from conditions like:

  • eye disease (glaucoma)
  • heart failure
  • hyperthyroidism
  • hypertension (high blood pressure)
  • increased heart rate (tachycardia)
  • liver disease
  • urinary tract blockag
  • severe constipation

Antimuscarinics (including oxybutynin) can cause confusion, memory loss, and worsening mental function in older people. If you are older than age 65, try other treatments first. If an MRA is prescribed, ask your doctor to consider modifications to other medications to help reduce side effects.

Always check your medical history with your doctor!

Possible drug interactions

Antimuscarinics are taken by mouth, and enzymes in the liver break down the drug.

  • Grapefruit juice and drugs that inhibit liver enzymes should be avoided.
  • Natural substances like St John’s wort can also diminish the therapeutic effect of certain antimuscarinics.

Ask your doctor about drug interactions. Read the prescription instructions for your drug treatment carefully to make sure you take medications correctly.

Side effects

Muscarinic receptors exist throughout the body. Drug treatment for bladder contractions affects all of these receptors throughout the body. As a result, you may have side effects.

Common side effects

Rare side effects

Contact your doctor right away if you experience

  • Dry mouth and eyes
  • Acid reflux (heartburn)
  • Constipation

 

  • Common cold symptoms
  • Blurred vision
  • Dizziness
  • Difficulty urinating
  • Dizziness
  • Severe drowsiness
  • Fever
  • Severe hallucinations
  • Confusion
  • Trouble breathing
  • Clumsiness and slurred speech
  • Fast heartbeat
  • Flushing and warmth of the skin
  • Difficulty emptying the bladder

Drug therapy with Beta-3-agonist

Taking Beta-3 agonist

Beta-3 agonists (β3-agonists) are a new class of drugs. They target β3 receptors in the bladder muscle. This signals the bladder muscle to relax. As a result, bladder contractions are reduced. Your bladder can hold urine longer, and you will feel the need to urinate less often. Currently, only one β3 agonist—mirabegron—is available for the treatment of OAB symptoms.

Mirabegron is worth considering if your symptoms did not improve or if you had bothersome side effects when taking antimuscarinics. The side effects are usually mild, and mirabegron does not cause difficulty emptying the bladder.
Mirabegron is taken by mouth once daily with or without food. Swallow the pill whole—do not break it up or crush it. The adult dose is usually 50 mg. If you have kidney or liver problems, a lower dose of 25 mg is suggested.

β3 agonist is not recommended for patients who:

  • Have certain conditions like kidney or liver impairment. (Always check your medical history with your doctor)
  • Have a history of severe high blood pressure
  • Use drug treatment that inhibits liver enzymes
  • Are pregnant or breastfeeding
  • Are younger than 18 years old

Always check your medical history with your doctor!

Possible drug interactions

Mirabegron is taken by mouth, and enzymes in the liver break down the drug.

  • Grapefruit juice and drugs that inhibit liver enzymes should be avoided.
  • Other medications may affect how mirabegron works.

Ask your doctor about drug interactions. Read the prescription instructions for your drug treatment carefully to make sure you take medications correctly.

Side effects

Drug treatment for bladder contractions affects nerve endings throughout the body. As a result, you may have side effects.

Common side effects

Contact your doctor right away if you experience:

  • Increased blood pressure
  • Common cold symptoms
  • Urinary tract infection
  • Constipation
  • Diarrhoea
  • Dizziness
  • Headache
  • Increased blood pressure
  • Difficulty emptying the bladder
  • Swelling of the lips, face, tongue, or throat (angioedema), with or without difficulty breath

The treatment explained

This animation shows what happens when you are receiving drug therapy with antimuscarinics or a β3-agonist.

Follow-up

Schedule an appointment (follow-up) to see your doctor at 4–6 weeks after starting drug treatment. You and your doctor will discuss whether drug treatment seems to be helping and any side effects you have. Your doctor will also check your blood pressure.

Bladder diary

Your doctor may ask you to keep a bladder diary. You should note how much fluid you drink, how often you urinate, and how much urine you produce during the day and at night. The bladder diary is important because it helps your doctor understand your symptoms better, and your treatment can be adjusted if necessary. You can print a bladder diary here.

What if my drug treatment does not improve my OAB symptoms?

Sometimes the drug your doctor prescribed does not improve your symptoms. In that case, your doctor might switch you to another drug, antimuscarinic (MRA) or β3-agonist, or other treatment options. Together with your doctor, you can decide which approach is best for you.

Common other treatment options for OAB symptoms are:

  • Botulinum toxin (Botox) bladder injection
  • Nerve stimulation, also known as ‘neuromodulation’
  • Surgery to increase bladder volume

Support and questions

It can help and might make you feel more comfortable if your partner, relatives, or friends read the information regarding drug treatment. Write down all of your questions to remind you of any important points you need to discuss with your doctor or nurse.

Let someone accompany you to an appointment to help you remember any questions you may need to ask.

The information does not take into account your individual medical situation. If you have questions or concerns about your health, please contact your doctor. No information can replace a personal conversation with your doctor.

This EAU Patient Information project is supported by an educational grant from Astellas.

This information was produced by the European Association of Urology (EAU) Patient Information Working Group.
Prof. Dr. C.R. Chapple, Dr. F. Esperto, Dr. J-P. Jessen, Dr. R. Pereira e Silva

The content is written independently of the sponsor and judged free of any conflict of interest.