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OAB symptoms are more common as people age, but they are not a normal part of ageing. They can be treated.

If you have bothersome symptoms, it is important that you go to your doctor. Try not to be embarrassed in discussing your situation. If self-management and lifestyle changes cannot control your symptoms, your doctor may suggest drug therapy. The goal is to reduce the urgent need to urinate and the number of times you need to go, as well as to prevent leakage episodes. Drugs used for OAB are antimuscarinic drugs or mirabegron (beta-3 agonist). Together with your doctor, you can decide which type of drug treatment is best for you.

Factors which influence this decision include:

  • Your symptoms
  • Your medical history
  • Any other medication you are taking
  • Drugs available in your country
  • Your personal preferences and values

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.

There are several MRAs. These work similarly, but they may have different side effects and be more or less tolerated by patients.

Taking antimuscarinics

Most antimuscarinics are taken by mouth once daily with or without food, although they can also be administered through a transdermal patch. 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.

Antimuscarinics are not recommended for patients who are pregnant or those who suffer from conditions like:

  • glaucoma (eye disease)
  • severe liver disease
  • urinary retention
  • severe constipation

Possible drug interactions

When antimuscarinics are taken by mouth, interactions with other drugs can occur. 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.

Antimuscarinics can cause confusion, memory loss, and worsening mental function in older people. If an MRA is prescribed, your doctor may consider to modificate other medications to help reduce side effects.

If you experience side-effects, contact your doctor to reconsider your therapy. Options might include:

  • another type of antimuscarinic drug
  • drug therapy with a beta-3 agonist
  • if you experience dry mouth, the transdermal administration of an antimuscarinic can avoid this side effect

Drug therapy with Beta-3 agonists

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 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. Beta-3 agonist is not recommend for patients who:

  • Have certain conditions like severe kidney or liver impairment.
  • Have a history of severe high blood pressure
  • Are pregnant or breastfeeding
  • Are younger than 18 years old

Possible drug interactions

Mirabegron is taken by mouth, and drug interactions can occur. 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 breathing

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 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 or prescribe further tests such as a bladder diary.

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

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.