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Conservative Treatment
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Samer Shamout, Lysanne Campeau
β3-Adrenergic receptor agonist mirabegron (Myrbetriq™ in North America and Betmiga™ in Europe) evolves as a future alternative in the management of NDO. Although mirabegron avoids antimuscarinic-related adverse events such as dry mouth, constipation, and cognitive impairment, it increases the risk of certain cardiovascular system side effects. Current evidence is insufficient to support effectiveness of mirabegron over anticholinergic agents in this population due to the lack of efficacy to improve urodynamic parameters.78–81
Urogynaecology and pelvic floor problems
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Mirabegron is a more recently developed medication for OAB, which is a beta 3-adrenergic agonist. Mirabegron acts upon the sympathetic neurones innervating the bladder, to enhance relaxation of the detrusor. Therefore it is acting more on the storage function of the bladder than do anticholinergic medications, which act by suppressing voiding. Mirabegron can be used simultaneously with an anticholinergic drug.
Urinary Incontinence in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Nicole Strong, Sara Z. Salim, Jean L. Nickels, K. Rao Poduri
The only beta-3 adrenergic agonist used in UI treatment, at this time, is mirabegron (Myrbetriq).1 It is a daily medication that is better tolerated than anticholinergic medications due to its fewer side effects profile.1 The main side effects that can occur include hypertension and tachycardia. It should not be used in patients with poorly controlled blood pressure, specifically if systolic is above 180 or diastolic is above 110.1 Mirabegron is typically used as a second- or third-line option when anticholinergic medications are either contraindicated, not effective, or have intolerable side effects.49
Evaluating vibegron for the treatment of overactive bladder
Published in Expert Opinion on Pharmacotherapy, 2021
Tomasz Rechberger, Andrzej Wróbel
Mirabegron was the first β3AR agonist introduced to the pharmaceutical market for OAB treatment. Current status of mirabegron, the only currently worldwide used β3-adrenoceptor agonist, in the treatment of overactive bladder symptoms is well recognized as a very effective alternative to antimuscarinic agents [4]. Bearing in mind previously published data it seems rather obvious that mirabegron inhibits mechanosensitive bladder afferent activity mainly in Aδ-fibers thus increasing bladder capacity without affecting bladder contraction [5]. This was confirmed in clinical practice by the observation of absence of an increase in post-void residual volume when using mirabegron and this is an indirect evidence that in the bladder β3AR agonists exert its action via sensory mechanisms without affecting directly detrusor muscle motor function.
The cognitive safety of antimuscarinics in the treatment of overactive bladder
Published in Expert Opinion on Drug Safety, 2020
George Araklitis, Dudley Robinson
Mirabegron is a beta-3 adrenoceptor agonist, which can induce bladder detrusor muscle relaxation, increasing bladder capacity, and improving OAB symptoms [85]. Because it acts on the beta-3 adrenoceptors, it does not have the anticholinergic side effects and does not add to the anticholinergic load, which may make it a good choice in the older, complex patient [85]. These receptors are commonly found in the cardiovascular system and not in the central nervous system. Mirabegron is also a substrate for the P-gp system, allowing it to be actively transported out of the brain if it does have the potential to exert an effect. The evidence suggests that it is safe in those older than 65 years, with no patients having an increased heart rate and hypertension was more common in those using tolterodine (14.5%) over mirabegron (9.3%) [85].
The clinical pharmacology of the medical treatment for overactive bladder in adults
Published in Expert Review of Clinical Pharmacology, 2020
Hadi Mostafaei, Shahrokh F. Shariat, Hanieh Salehi-Pourmehr, Florian Janisch, Keiichiro Mori, Fahad Quhal, Sakineh Hajebrahimi
Based on the availability of medications, prescribing the extended-release (ER) formulation of oral anticholinergics or mirabegron is the first drug choice. Depending on the severity of the symptoms, we adapt the dosages of the medication. First follow up visit is arranged for 1 month after the visit (this may take up to 8 weeks for treatment with mirabegron). We may have different strategies based on the level of treatment efficacy such as using flexible doses (increasing or reducing the dosage) or adding a drug from other formulations such as mirabegron to solifenacin (both in low dose to reduce the adverse events) or stopping medication in case of no efficacy or serious adverse events. In some patients with tolerable adverse events, one can increase the dose to titer to efficacy. We usually wait for the highest patient satisfaction and then try to taper the doses slowly until stopping the medication, when possible.