Medications For Overactive Bladder
Medications for overactive bladder target muscles that control bladder function. These drugs can be used alone or in combination, and include:
- Anticholinergics such as trospium , darifenacin and oxybutynin relax bladder muscles. They are the most commonly prescribed medications for overactive bladder and are well tolerated. Side effects include constipation and dry mouth.
- Tricyclic antidepressants, such as imipramine and doxepin, stop contractions in the smooth muscle of the bladder. Side effects include dizziness, fatigue, changes in vision, nausea, insomnia, and dry mouth.
What Other Drugs Will Affect Imipramine
Taking imipramine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking imipramine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can affect imipramine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all other medicines you use.
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Selective Serotonin Reuptake Inhibitors
SSRIs block the reuptake of serotonin. SSRIs are the most widely prescribed new class of antidepressants, and fluoxetine was the first in this new class on the market in the United States. But do the SSRIs or any of the other new antidepressants work to treat IC/BPS? The jury is still out. One reason for the development of newer antidepressants was to reduce the negative side effects of the TCAs. In doing so, some of the side effects that actually help to treat IC/BPS were lost .
While the results of studies using SSRIs for various medical conditions besides depression are encouraging, very little data is available regarding their use in treating IC/BPS.
Seven Effective Treatments For Overactive Bladder
Overactive bladder occurs when sudden or frequent urges to urinate become hard to control, and can often lead to leakage .
In order to best treat overactive bladder, a urologist must pinpoint the underlying cause. Treatment will depend on symptom severity and the degree to which they impact someone’s quality of life. In general, there are three approaches to treatment: medication, behavioral interventions, and surgery.
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Rated For Primary Nocturnal Enuresis Report
My son was prescribed this at age 5 for primary nocturnal enuresis. It worked for 9 months then quit. The doctor recommended increasing the dosage, but I took my son in to discuss it. The doctor discovered he had not grown since he started it. He stopped taking it but didnt start growing again for another 1.5 months. At age 8, he was still showing delayed bone growth by 10.5 months and had to start seeing an endocrinologist who said there is nothing he can do because he did start growing again. It was a side effect of the drug and my son may never make up the lost growth.
Rated For Depression Report
Ive been taking this for about three weeks. It has helped me SO MUCH. I used to cry almost everyday which was accompanied by suicidal thoughts. Now I honestly dont think about those things or have fits of depression like I used to . I havent had one episode since taking this medicine. I just truly feel happier. Its not a miracle worker, but its definitely improved my life. The only side effect was dry mouth/a bad taste in my mouth for the first few days of taking it. Also, the first couple days I did have mood swings but now everything feels balanced out. So glad I didnt let the initial side effects make me give up on this medication.
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What If I Forget To Take It
If you forget to take your medicine, take it as soon as you remember unless the next dose is due in less than 6 hours. In this case skip the missed dose and take your next one at the usual time.
Do not take a double dose to make up for a missed dose.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
Which Drugs Or Supplements Interact With Imipramine
Other medications and drugs that slow the brain’s processes, such as alcohol, barbiturates, benzodiazepines, for example, lorazepam , diazepam , temazepam , oxazepam , clonazepam , zolpidem , and narcotics, may add to the effect of imipramine on the brain.
Reserpine, given to patients taking TCAs, can cause agitation and anxiety. Imipramine and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid , phenelzine , tranylcypromine , and procarbazine , since high fever, convulsions and even death can occur.
Concurrent use of cimetidine can increase imipramine blood levels by reducing elimination of imipramine from the body and possibly lead to imipramine- related side effects. Other drugs which share this effect include propafenone , flecainide , quinidine , methylphenidate, and fluoxetine .
Anticholinergic Drugs For Oab
The largest class of drugs used to treat OAB is anticholinergic drugs. They work by blocking a chemical in your body called acetylcholine. This chemical sends a message to your bladder to contract. By blocking this chemical, these drugs reduce the contractions that cause you to release urine. In studies that compared the drugs, all anticholinergics worked in treating OAB.
Anticholinergics are sold under different brand names. Some are also available as generic drugs. These medications include:
All of these drugs except for Oxytrol come as either tablets or capsules that you take by mouth. Oxytrol is available as a skin patch.
The most common side effects of anticholinergic drugs include:
Seniors have the greatest risk of side effects from these drugs. These medications may also cause drowsiness and an increased risk of falls in seniors. Oxybutynin may cause more side effects than the other drugs in this class. However, taking oxybutynin in its extended-release form may reduce some of the side effects. Anticholinergics may also worsen dementia symptoms and should be used with caution in people with this disease.
Clinical Trials Of Darifenacin
Darifenacin has been the subject of several randomized clinical trials. Pooled data analysis from 3 studies enrolled over a thousand patients with a minimum 6-month history of overactive bladder symptoms including urgency, frequency, and urge incontinence. All participants had a 2-week washout and a 2-week placebo run-in prior to the beginning of the trial. Patients were randomized to be given either 1) darifenacin 7.5 mg or matched placebo or 2) darifenacin 15 mg or matched placebo. Outcome data were collected by use of an electronic diary. Although there was a noted placebo response, both doses of darifenacin were superior to placebo in alleviating symptoms associated with OAB . Darifenacin has also been compared with oxybutynin as well as a matched placebo. Seventy-six patients had detrusor overactivity verified with urodynamics with at least 4 urge incontinence episodes per week and a frequency of at least 8 micturitions per day. All patients underwent a 2-week run-in period prior to 2 weeks of treatment in each arm. A paper diary was used to assess outcomes. Results revealed a comparable efficacy with oxybutynin, in comparison to the placebo arm with reduced a side effect profile .
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Drugs For Treatment Of Urinary Incontinence
teaserWalsgrave University Hospital of Coventry, UK
Vijay AnandYork House Medical Centre, UK
Urinary incontinence is a common, chronic condition which requires long-term management and is associated with significant negative impact on an individual. Medical management associated with conservative measures still plays an important role in its management. Surgery is still the mainstay treatment of stress urinary incontinence but it is not free from complications. When drugs are prescribed, long-term adherence to therapy is poor. Efforts to improve the clinical effectiveness of pharmacological therapies have included extended release formulations and alternative delivery mechanisms.
Malfunction occurring at various levels may result in bladder control disorders, which can be classified as disturbances of filling/storage or voiding/emptying. Failure to store urine may lead to various forms of incontinence , and failure to empty can lead to urinary retention, which may result in overflow incontinence. The disturbed function can be improved by agents decreasing detrusor activity, increasing bladder capacity and/or increasing outlet resistance.1 Several promising drug targets have been identified to improve the pharmacological treatment of UI.2
Drugs acting on membrane channelsAt present there is insufficient evidence to suggest that calcium channel blocking agents and potassium channel opening agents are effective in the treatment of DO.
Reversible Inhibitors Of Monoamine Oxidase Type
Similar to monoamine oxidase inhibitors , RIMAs reduce the activity of monoamine oxidase. Monoamine oxidase breaks down noradrenaline, serotonin and other brain chemicals. RIMAs increase the amount of noradrenaline and serotonin in the brain, with fewer risks, side effects, and dietary restrictions than MAOIs.
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Surgical Treatment For Overactive Bladder
Surgery may recommended for severe cases. The two most-commonly used procedures are:
- increases bladder size by removing a section of the bowel and adding it to the bladder. Increased bladder size allows someone to store more urine, reducing the urge to urinate. Possible complications include infection, blood clots, bowel obstruction, urinary fistula, and an increased risk of bladder tumors .
- Sacral Nerve Stimulation is a newer surgical technique that involves placing a small electrical device in the lower back. The device sends electrical impulses to the sacral nerve, which improves control of the muscles in the bladder and pelvic floor.
Dosage & Treatment Plan
Dosages for TCAs range from 10 100 mgs usually taken in the evening or at bedtime. It is typical to start out with a very low dose and then gradually increase the dosage every week until you find that your symptoms are improving.
Dosages for other types of antidepressants vary, depending on specific medicine.
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What If I Take Too Much
If you take too much mirabegron, it is unlikely to harm you.
If you take an extra dose by mistake, you might get some of the common side effects, such as increased heart rate, or headache and dizziness.
Urgent advice: Contact 111 now for advice if:
You’ve taken more than your usual dose of mirabegron and:
- you’re having side effects
Call or go to 111.nhs.uk
Studies Testing Antidepressants To Treat Ic/bps
With the exception of the TCA called amitriptyline , there are limited studies evaluating the use of antidepressants in IC/BPS. While it is general knowledge that TCAs can help with the symptoms of IC/BPS and that they are a first-line therapy for IC/BPS, it was not until 2004 that researchers put amitriptyline to the test for use in IC/BPS in a placebo-controlled study. Researchers tested amitriptyline, the TCA most commonly used to treat IC/BPS, in a randomized, prospective, placebo-controlled trial for IC/BPS. The researchers found that symptom scores dropped, and that pain and urinary urgency improved significantly in the amitriptyline group compared with the placebo group. Urinary frequency and functional bladder capacity improved more in the amitriptyline group, but the difference was not statistically significant. In a follow-up study, the drug proved to be effective for long-term management of IC/BPS.
Researchers out of the Albert Einstein College of Medicine presented a study on another TCA called desipramine at the 2012 American Urological Association meeting. The study found that desipramine was effective in treating both overactive bladder and OAB with bladder pain. The researchers concluded patients treated with amitriptyline should consider desipramine if they experienced side effects linked to amitriptyline, like memory problems.
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Evaluating Patients With Overactive Bladder
All medications should be reviewed for those that may affect urinary function, output, and so on. Diuretics, by increasing urinary output, clearly increase urinary frequency. Occasionally patients report night-time administration, a reversible cause of nocturnal polyuria. Various medications, including anticholinergics, narcotics, and calcium channel blockers, may decrease bladder contractility, leading to inability to completely empty the bladder and more frequent voiding. In addition, the use of sedatives may lead to deceased mobility and inability to get to the bathroom in time, leading to incontinence.
Physical examination should include the abdominal, genitourinary, rectal, and neurologic systems. It is important during the abdominal examination to make sure the bladder is not palpable. The genitourinary examination in women should include a pelvic examination to rule out an obstructing, kinking cystocele, atrophic vaginitis, and urethral diverticulum , and a rectal examination to rule out constipation, which can lead to OAB. In the male the size of the prostate and assessment for nodules is performed. Neurologic examination should include lumbar and sacral reflexes as well as mental status.
Who Can And Cannot Take Mirabegron
Mirabegron can be taken by adults .
It is not suitable for everyone. To make sure it’s safe for you, tell your doctor or pharmacist before starting mirabegron if you:
- have had an allergic reaction to mirabegron or any other medicines in the past
- have liver or kidney problems
- have high blood pressure
- are not able to pee or empty your bladder completely
- have a blockage in your bladder
- have a heart problem called QT prolongation
- are pregnant, trying to get pregnant or breastfeeding
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What Should I Avoid While Taking Imipramine
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with imipramine.
Avoid driving or hazardous activity until you know how imipramine will affect you. Your reactions could be impaired.
Avoid exposure to sunlight or tanning beds. Imipramine can make you sunburn more easily. Wear protective clothing and use sunscreen when you are outdoors.
What Is The Role Played By Beta
A systematic review , with all the studies above, concludes that mirabegron is as effective as most antimuscarinics, including LA tolterodine, 4 mg, compared to placebo in relation to the primary outcomes . Regarding tolerability, the data suggest that patients who took mirabegron had a similar rate of adverse events compared to those in the placebo group, whereas the rate in the antimuscarinic group was the highest.6262 Thiagamoorthy G, Kotes S, Zacchè M, Cardozo L. The efficacy and tolerability of mirabegron, a 3 adrenoceptor agonist, in patients with symptoms of overactive bladder. Ther Adv Urol. 2016 8:38-46.
The most common adverse events observed with mirabegron include: hypertension, nasopharyngitis, urinary tract infections, headache, constipation, upper respiratory tract infection, arthralgia, diarrhea, tachycardia, abdominal pain and fatigue.6363 Bragg R, Hebel D, Vouri SM, Pitlick JM. Mirabegron: a beta-3 agonist for overactive bladder. Consult Pharm. 2014 29:823-37.
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Duloxetine Reverses The Symptoms Of Overactive Bladder Co
Solifenacin acts mainly via peripheral pathways in detrusor overactivity.
Mirabegron acts mainly via peripheral pathways in detrusor overactivity.
Central pathways are responsible for effects of duloxetine in depression.
Central pathways are responsible for effects of duloxetine in detrusor overactivity.
Before Taking This Medicine
You should not use imipramine if you are allergic to it, or if:
Do not use imipramine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.
Tell your doctor if you have ever had:
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.
It is not known whether imipramine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breastfeed while using imipramine.
Do not give this medicine to a child without medical advice. Imipramine is not approved to treat depression in anyone younger than 18 years old. Imipramine should not be used to treat bed-wetting in a child younger than 6 years old.
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How To Cope With Side Effects
What to do about:
- feeling sick â try taking mirabegron with a meal or snack. It may also help if you stick to simple meals and avoid rich or spicy food.
- constipation â eat more high-fibre foodsâ¯such as fresh fruit, vegetables and cereals, and drink plenty of water.â¯Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor.â¯Watch this short video about how to treat constipation.
- diarrhoea â drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- urinary tract infection â if you think you have a UTI, ask a pharmacist or doctor to recommend a treatment. Tell them that you are taking mirabegron.
- headache â make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask a pharmacist to recommend a painkiller. Talk to your doctor if the headaches continue or are severe.
- feeling dizzy â stop what you’re doing and sit or lie down until you feel better. Do not drive, ride a bike or operate machinery until it passes. If you are still having dizzy spells after a week, speak to your doctor.
- fast heart rate â lie down and try to relax. This is usually nothing to worry about and will pass. Contact 111 if your heart beat does not slow down after resting, or if you have chest pain.