Section 17
Neurogenic Bladder
Overactive & Neurogenic Detrusor Therapies
5 AGENTS
Oxybutynin
Ditropan XLAntimuscarinic
- Forms
- Tab: 5mg (IR) | ER tab: 5, 10, 15mg | Patch: 3.9mg/day
- Dose
- IR 5mg BID-TID (max 5mg QID) | ER 5-30mg once daily
- MOA
- Muscarinic (M3) blockade, relaxes detrusor
Tolterodine
DetrolAntimuscarinic
- Forms
- Tab: 1, 2mg | ER cap: 2, 4mg
- Dose
- 2mg BID (or ER 4mg once daily); 1mg BID with hepatic impairment or strong CYP3A4 inhibitors
- MOA
- Muscarinic receptor blockade
Solifenacin
VesicareAntimuscarinic
- Forms
- Tab: 5, 10mg | Susp: 1mg/mL (Vesicare LS)
- Dose
- 5mg once daily, may increase to 10mg; pediatric neurogenic detrusor overactivity is weight-based
- MOA
- M3-selective muscarinic blockade
Mirabegron
MyrbetriqBeta-3 agonist
- Forms
- ER tab: 25, 50mg | Granules (oral suspension)
- Dose
- Adults: 25mg once daily, increase to 50mg after 4-8 weeks | Pediatric NDO age 3+: weight-based; 35kg or more 25mg daily, up to 50mg after 4-8 weeks, with food
- MOA
- Beta-3 adrenergic agonism, relaxes detrusor during filling
Vibegron
GemtesaBeta-3 agonist
- Forms
- Tab: 75mg
- Dose
- 75mg once daily with or without food
- MOA
- Selective beta-3 adrenergic agonism, ↑bladder capacity