The FDA approved medications, or drugs, currently available on the U.S. market for the treatment of urinary incontinence are for a specific condition called overactive bladder (OAB). Some are also used for OAB with urge urinary incontinence (UUI). You may have seen advertisements on television or in magazines for these medications. Most of the prescription drugs for OAB partially calm the bladder muscles that cause abnormal contractions, thereby reducing the frequency and severity of the overwhelming urge to urinate. Some of these drugs may also increase the bladder’s capacity to hold urine and delay the initial urge to void. This class of drugs is referred to as antimuscarinics.
The currently FDA approved antimuscarinic drugs for OAB are: Oxybutynin, Tolterodine, Solifenacin, Hyoscyamine, and Darifenacin. These drugs are sold under the names of: Ditropan, Detrol, Vesicare, Enablex, Levbid, Cytospaz and Oxytrol. Most of these are oral medications and need a doctor’s prescription. Only one drug will be available over-the-counter (OTC) as of September 2013, and it is in a skin patch form (Oxytrol) for women only.
Note: Drugs that are currently approved may be suddenly taken off the market, and new drugs are being introduced. Your healthcare provider and pharmacist can help you know which current drugs on the market may be the best for your circumstances.
The newest drug approved for OAB is in a different class, and it is Mirabegron (a beta-3 adrenergic agonist). It is also approved for use with urge urinary incontinence. Mirabegron is sold under the name Myrbetric. It works a bit differently than the antimuscarinics, as it relaxes the bladder’s smooth muscle while it fills with urine, thereby increasing the bladder’s capacity to hold/store urine.
Antispasmodic drugs may also be prescribed by your doctor for OAB as they can help relax the bladder muscle.
Who May Need a Prescription?
These prescription drugs are for individuals with over active bladder or OAB. Some of these drugs are also used for people with OAB who also experience leakage of urine with the sudden urge to urinate (UUI).
Possible Side Effects
There are some side effects associated with the drugs that affect some people more than others. However, side effects differ among the drugs. While you may have a particular side effect from one medication, you may find another OAB drug doesn’t have the same side effects, and you will tolerate the next one much better.
The most common possible side effects include (others side effects are possible):
- Dry mouth
- Dry eyes
- Confusion, forgetfulness, and possible worsening of mental function, particularly in older people with dementia, such as Alzheimer’s disease
- Rapid heart rate
Note: Some drugs for overactive bladder cannot be used in combination with other prescription drugs or with certain medical conditions. Your healthcare provider should do a thorough and complete medical exam and history with you, prior to prescribing any of these medications. You must also alert your healthcare provider immediately of any possible side effects, as some could be serious.
Many healthcare providers recommend that individuals with OAB do an initial trial with a drug to see if they are affected by any side effects that cannot be tolerated. If you want to stop a prescribed medication, first speak with them about that decision. Be sure to ask your healthcare provider about trying a different drug if the first one does not give you the desired outcome or if the side effects make you want to stop taking the medication. Understand that most drugs take a few weeks before they become effective. Be sure to ask how long you should try a medication before deciding that it may not be working for you and trying another one.
Reasons to Take Drugs for Overactive Bladder
- Taking medication is not an invasive treatment, like surgery. You can stop taking the medication after consulting with your doctor if you don’t see any positive changes or you are experiencing troublesome side effects.
- There are many drugs to choose from and new medications are being introduced. This makes it more likely you will find something that works for you.
- Many people find good success taking a medication. Some find increased relief in combining a medication with prescribed pelvic floor therapy (strengthening the muscles of the pelvic floor).
Reasons Why You May Not Want to Start a Prescription
- Drugs for overactive bladder are not a “cure” — they will only help the urge urinary incontinence and OAB for as long as you take them. Once you stop taking the drug, your symptoms will return.
- There are side effects associated with many of these drugs.
- There is the ongoing cost of paying for a prescription each month if your insurance does not cover the cost.
- In many cases the medication will reduce your leakage and/or the extreme urgency to urinate, but it may not stop it completely, so you may still need to use some protection (such as an absorbent incontinence pad).
Key Points to Remember
- There are several medications available for OAB and new ones are being introduced.
- Each medication works in a slightly different way and may have side effects that vary for each person.
- If you’re unhappy with the medication you are taking, it’s important to speak with your healthcare provider. He or she can advise if you’re taking the medication correctly, if it is the right dosage, and if you’ve tried it long enough to see the positive effects.
- If your healthcare provider understands your incontinence symptoms and any medication issues you have, he /she may be able to recommend a different medication that may provide you with better results. It’s important to keep in contact with your healthcare provider and let them know exactly what kind of progress you are making — or not making — on any medication.
Medical Reviewer: Tamara Dickinson, RN, CURN, CCCN, BCIA-PMDB
Ms. Dickinson, RN, CURN, CCCN, BCIA-PMDB, is a nationally and internationally recognized authority in urodynamics, incontinence, voiding dysfunction, and pelvic floor dysfunction. Ms. Dickinson is board certified in urology nursing and continence nursing and is certified in biofeedback for pelvic muscle dysfunction. With 20+ years in the field, Ms. Dickinson is experienced in pelvic floor therapy including biofeedback and neurogenic voiding dysfunction, as well as other pelvic floor and continence therapies such as sacral neuromodulation and pessaries. She is a frequent national presenter on these topics. Ms. Dickinson is the Senior Research Nurse in Continence and Voiding Dysfunction in the Department of Urology at UT Southwestern Medical Center in Dallas, TX. She is a Past President of the Society of Urologic Nurses and Associates (SUNA. She is the Chair of the Continence Promotion Committee and the School of Urodynamics of the International Continence Society. Ms. Dickinson is a recipient of the SUNA President’s Trophy for outstanding contributions to the association. She also received the Past President’s Lectureship Award at the 2006 SUNA Annual. Ms. Dickinson is a member of the Advisory Board for the Simon Foundation for Continence.