Overactive bladder, urinary urgency, urgency incontinence and unrelenting frequency. In the absence of a neurologic disease, all these conditions are deemed the same. Gotta go, cant make it one time…call it overactive bladder. Under normal situations you only want your bladder to contract and squeeze out urine when you are ready. With overactive bladder your bladder squeezes down at the wrong time. Think of overactive bladder as a bladder that contracts when you don’t want it to, like when you are in the car or in the mall for example.
The main drug therapy for this is a category of drugs called anticholinergics or more specifically antimuscarinics. These drugs work by interfering with the bladder’s contraction ability. Think of it as preventing the gas pedal from being pressed. Drugs such as oxybutinin, Vesicare, Enabelex, Toviaz, and many others are well known and are very frequently used. While these drugs are very popular and prescribed with great frequency, many patients stop using them. The reason is that they often don’t work so well in the long run and have familiar side effects such as dry mouth, dry eyes and constipation. As a result many if not most people stop using the medication after a number of months.
Myrbetriq is a new drug that works by a different mechanism. Instead of preventing the gas pedal, this drug works by stepping on the brakes. It stimulates the inhibitory mechanism of the bladder. The drug is new and trials look good and the FDA has approved the medicine.
A more potent approach may however be to use both drugs together. Early phase studies show promise. This combination of drugs has not been approved by the FDA though each drug has been approved individually. Drug trials in the US are anticipated.
Call for details.
Eugene Dula, M.D., FACS
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