Tolterodine Tartrate Immediate Release And Controlled Release
Tolterodine is a competitive muscarinic receptor antagonist available in an IR and ER formulation. Tolterodine-ER is available as a 2 mg or 4 mg daily dose. Tolterodine-IR is dosed at 12 mg twice daily .
Tolterodine undergoes hepatic metabolism following oral ingestion, forming a 5-hydroxymethyl derivative that is pharmacologically active, having similar antimus-carinic activity to tolterodine. Tolterodine and 5-HMT are highly selective for muscarinic receptors. Hepatic and renal insufficiency can significantly alter the metabolism of tolterodine.
A Cochrane review comparing anticholinergic agents for OAB found that compared with OXY, tolterodine had equivalent effects on QOL, patient-reported cure or improvement, leakage episodes, and voids in 24 hours. Tolterodine was better tolerated than OXY, with fewer withdrawals due to adverse events and less risk of dry mouth.
Tolterodine significantly increases the cardiac QT interval at doses of 8 mg/day or higher hence, the recommended dose should not exceed 4 mg/day. This is of particular relevance in patients with a history of known prolongation of QT interval, or who are taking class IA or III antiarrhythmic medications.
Adverse effects are consistent with its antimuscarinic mechanism of action. The most common adverse events reported by patients receiving tolterodine-ER were dry mouth , headache , constipation , and abdominal pain .
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
Overactive Bladder At Night
If you find that you wake up to urinate more than one time per night, you may have a condition called nocturia, or overactive bladder at night. Nocturia isnt the same as overactive bladder. In fact, some people who experience no OAB symptoms during the day can still have nocturia.
Nocturia is more common in people over age 60, but one in three adults over 30 need two or more trips to the bathroom each night. Most adults can sleep six to eight hours without waking up. Others may only need to wake up once.
If you require more bathrooms breaks during your slumber, you may be experiencing overactive bladder at night.
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How We Made Our Recommendation
Our evaluation is primarily based on an independent scientific review of the evidence on the effectiveness, safety, and side effects of overactive bladder medications. A team of physicians and researchers at the Pacific Northwest Evidence-Based Practice Center conducted the analysis.
A synopsis of that forms the basis for this report. A consultant to Consumer Reports Best Buy Drugs is also a member of the Pacific Northwest EPC research team, which has no financial interest in any pharmaceutical company or product. The full Pacific Northwest EPC review of overactive bladder drugs is available here. . We also relied on research conducted by the Agency for Healthcare Research and Quality and the Cochrane Collaboration.
Evaluation Of Patients With Oab Syndrome
A detailed history is extremely important and can clearly highlight possible risk factors for OAB. Aspects related to pre-existing conditions or surgery , eating habits, medication that interferes with urinary function are crucial. History should be focused especially on voiding and storage lower urinary tract symptoms, the severity of symptoms and their impact on quality of life .
A focused clinical examination is imperative, as it can highlight risk factors and pre-existing conditions. It should include abdominal examination, digital rectal examination of the prostate in males and vaginal examination in women . A residual postvoid should also be performed using ultrasound or a straight catheter, especially in groups at risk of urinary retention .
Symptom questionnaires should be used especially to highlight the impact of the condition on quality of life and to determine whether or not the patient should undergo treatment. There are numerous validated questionnaires, useful in highlighting the progression of treatment, but not currently widely used .
Urinalysis and urine culture are recommended for all patients in order to rule out other associated pathologies that may cause OAB-type symptoms . Blood tests can provide additional information including levels of creatinine and glycosylated hemoglobin .
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How To Take Oxybutynin
Use Oxybutynin exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Take oxybutynin with a full glass of water, at the same time each day.
You may take oxybutynin with or without food.
Swallow the extended-release tablet whole and do not crush, chew, or break it.
Measure liquid medicine with the supplied measuring device .
Part of a tablet shell may appear in your stool but this will not make the medicine less effective.
Store at room temperature away from moisture and heat.
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
Newer Agents For The Management Of Overactive Bladder
BENJAMIN J. EPSTEIN, PHARM.D., B.C.P.S., JOHN G. GUMS, PHARM.D., and EMERSON MOLINA, PHARM.D., University of Florida, Gainesville, Florida Fort Lauderdale, Florida
Am Fam Physician. 2006 Dec 15 74:2061-2068.
Overactive bladder is a clinical syndrome characterized by one or more symptoms of urgency , frequency , nocturia, and incontinence. In persons without overactive bladder, the need to empty the bladder becomes progressively more demanding in overactive bladder, urgency is characterized by unheralded messages of an immediate need to empty the bladder. These signals are difficult to delay. The inability to delay urination results in episodes of incontinence in up to 40 percent of patients with overactive bladder.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 2008 or.
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What Is The Most Important Information I Should Know About Oxybutynin
You should not use oxybutynin if you are allergic to it, or if you have:
- untreated or uncontrolled narrow-angle glaucoma
- a blockage in your digestive tract or
- if you are unable to urinate.
Tell your doctor if you have ever had:
- glaucoma
- a nerve disorder that affects your heart rate, blood pressure, or digestion
- myasthenia gravis or
- a stomach disorder such as gastroesophageal reflux disease or slow digestion.
Tell your doctor if you are pregnant or breastfeeding.
New Oab Medications On The Market
The latest medication that has been introduced to the market is Propiverine. Although its been around since 1993, drugs take years of studying and testing before being approved for patients. It is an anticholinergic drug, which as we said earlier, helps relax the smooth muscles in the body. This drug tackles all the symptoms of OAB.
There are doses specifically marketed towards children and their weight, for efficacy, of 5 years and up as well. This is significant, as children arent always the target market for overaction bladder medication.
If you havent had any success with other anticholinergic drugs, this drug has been compared to others in its class and was more successful at treating OAB symptoms in men and women, so it may be worth asking your doctor about.
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Temporary Chemical Denervation Of The Bladder Detrusor Muscle With Intravesical Botulinum Toxin A
OBTA is derived from Clostridium botulinum and selectively blocks presynaptic release of acetylcholine from nerve endings. This results in reduced contractility and a degree of muscle atrophy at the injection site . The result is not permanent due to the formation of new functional synapses. Another mode of action appears to be directly in the urothelium by inhibiting the release of neurotransmitters at this level, thus acting on the sensory system . OBTA is administered intravesically, by injection into certain areas of the bladder, using a cystoscope. The injection is made in 20 places at the level of the posterior wall of the bladder, above the trigone, to avoid extreme paralysis and significant urinary retention. The optimal dose is considered to be 100 units . Findings have shown that higher doses are more effective, but reported side effects have been much more common . Higher doses may be used in selected cases, but patients should be informed of the much higher likelihood of urinary retention .
The advantages are important: the symptoms are significantly improved in over 50% of patients, with marked improvement in quality of life, the favorable effect being maintained up to 3-5 years . SNM is contraindicated in patients who need frequent MRI, pregnancy or if a patient aims to conceive. The device is not cost-effective, and the patient must be very compliant because lifelong follow-up is needed . Sacral neuromodulation was FDA approved in 1997.
An Overactive Bladder Medication Overview
Overactive bladder, also called OAB, is a collection of symptoms rather than a disease process. OAB is characterized by a bladder that is overly sensitive. It causes urinary symptoms, such as frequent urination, and urination that is difficult to control may be experienced. In this article we take a look at overactive bladder medications and how they may help you manage your symptoms.
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Cautions With Other Medicines
Mirabegron may affect the way other medicines work, and other medicines may affect how mirabegron works.
Tell your pharmacist or doctor if you’re taking:
- digoxin, a medicine for heart failure or abnormal heart rhythm
- imipramine or desipramine, medicines for urinary incontinence or nerve pain
- dabigatran, a blood thinner
- ketoconazole or itraconazole, medicines used to treat fungal infections
- ritonavir, a medicine used to treat HIV
Which Medications Can Cause Oab
Some medications help with an overactive bladder and are used to treat the condition. But in other instances, your medications may be the culprit leading to urinary urgency.There are several classes of medications that may lead to OAB, including the following:
1. Diuretics
Diuretics are a type of medication that helps stimulate the kidneys to get rid of water and salt from the body in the form of urine. It is prescribed for people who may retain fluid. One of the most common drugs used is Lasix. Because it stimulates the body to make more urine, it often causes OAB.
When it comes to overactive bladder medication, there are four man drug classes. To learn how they treat OAB and their side effects, read on.
2. Blood Pressure Medications
Alpha-blockers are a type of medication used to reduce blood pressure. They work by dilating the blood vessels in the body, which can increase urinary urgency. Examples of alpha-blockers include prazosin and doxazosin mesylate.
3. Antidepressants
Different antidepressant medications may prevent the bladder from emptying completely. This may cause an increased urgency to use the bathroom. Some antidepressants also decrease a persons awareness that they need to urinate, which can lead to urinary incontinence.
4. Narcotic Pain Medications
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Sites Of Overactive Bladder Drug Action: Review Of The Micturition Reflex
The underlying pathophysiology of OAB syndrome is overactivity of the detrusor muscle. The tone of the detrusor muscle during filling and voiding relies on the counterbalance of the autonomic nervous system.
The interaction between the autonomic and somatic nervous system facilitates the voluntary control of micturition. During bladder filling, sympathetic stimulation is predominant, with activation of -ARs, via fibers of the hypogastric plexus, suppressing detrusor contraction. The bladder derives its motor supply from the sacral nerves via the parasympathetic nervous system. The release of acetylcholine from parasympathetic postganglionic nerves, mediated by the M muscarinic receptors, leads to detrusor contraction. Parasympathetic postganglionic nerves also release nonadrenergic, noncholinergic transmitters, such as adenosine triphosphate .
The pelvic and hypogastric nerves transmit sensory input from the bladder. The sensation of bladder filling is conveyed by myelinated fibers, whilst unmyelinated axons respond to noxious stimuli. Non-neuronal cells in the urothelium also have sensory and signaling properties that respond to chemical and mechanical stimuli. These cells have various receptors , and release chemical mediators, such as ATP, acetylcholine, and nitric oxide, triggering local vascular response and reflex detrusor contractions via neuralurothelial interaction.
What Medications Cause Overactive Bladder
An overactive bladder involves an uncontrolled urge or sudden need to urinate. Most of us have increased our fluid intake at some point, which led to more trips to the bathroom. But an overactive bladder is different. It does not occur due to an increase in fluids. Although, some medications can cause this. So, what medications cause overactive bladder? We will take a look shortly.
An overactive bladder is not the same thing as urinary incontinence. Urinary incontinence occurs when urine leaks out involuntary. Either condition can develop on its own, but they can also occur together. An overactive bladder can often lead to urinary incontinence.
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Overview Of Pharmacotherapy For Overactive Bladder
The drug classes used to treat OAB include anticholinergic agents, tricyclic antidepressants, desmopressin, hormone replacement therapy, 3-AR agonist, and intravesical Botox® . The latter two were the most recently introduced.
Anticholinergics have been to date, the mainstay of OAB treatment. Multiple randomized controlled trials have confirmed the effectiveness of these drugs for OAB, therefore recommendations for their use are based on level 1, grade A evidence. Most anticholinergics have a similar side effect profile, which includes dryness of the mouth and eyes, and constipation. As a result of this, other medical therapies have been introduced that do not share this side effect profile .
How Leading Oab Medications Measure Up
There are plenty of OAB medications to choose from, and just like any class of medication, not every drug will be suited to every patient.
Its crucial to consult with your doctor about your best route forward, considering allergies, known reactions, and any other medications you may be taking. Before you make your decision, compare the efficacy and side effects of the major classes of OAB drugs, and their leading brands.
Anticholinergics
Oxybutynin, tolterodine, trospium, darifenacin, solifenacin, and fesoterodine.
Research shows that all of the anticholinergics on the market are similarly effective for OAB, though some tend to bring more side effects than others. There are short-acting and long-acting versions of these drugs, and in most cases, the long-acting medication is more effective.
Oxybutynin is one of the drugs that cause problems: more people have quit this drug than any of the others, due to the dry skin and mouth, constipation, and upset stomach that it brought.
In contrast, studies show that solifenacin brought the least amount of side effects .
While tolterodine is also less disruptive than oxybutynin, it has been linked with a risk of hallucinations.
Tricyclic Antidepressants
Imipramine is the standard antidepressant medication for OAB. Major side effects are rare, but some people may experience milder symptoms, like sleepiness. Since they do tend to make you drowsy, this drug is ideal for those with night-time bladder problems.
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What Drugs And Food Should I Avoid While Taking Oxybutynin
Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Oxybutynin can decrease sweating and you may be more prone to heat stroke.
Drinking alcohol with this medicine can increase side effects.
Background To Medical Treatment Of Overactive Bladder
The mainstay of medical therapy for OAB management has been anticholinergic or antimuscarinic medications administered orally. Hormone replacement therapies, tricyclic antidepressants, and desmopressin have also been used for the management of OAB. One of the first anticholinergic medications used for OAB was immediate release oral oxybutynin although it has the drawbacks of multiple daily dosing and bothersome side effects, it is still being used today.
Subsequent numerous anticholinergic formulations have been developed to improve compliance by reducing the required dosing frequency and minimizing the side effect profile. More recent developments include the use of mirabegron, an oral -3 adrenergic receptor agonist, and the intravesical administration of botulinum toxin. These agents avoid anticholinergic side effects by their alternative mechanism of action.
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How Does The Medication Work
Medication has a direct effect on the bladder receptors that tell your brain how much you need to urinate. Medication can facilitate keeping the bladder in a state where you are comfortable storing urine, instead of feeling like it is going to leak out if you dont rush to the bathroom. It can give you the confidence to know you can go out without worrying you are going to leak, and you wont have to be preoccupied by how close you are to the bathroom.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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