treatments for overactive bladder

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Behavioral techniques, which improve bladder control by teaching persons to adopt new skills, are recommended first for treating OAB. These include self-care practices or lifestyle changes (such as weight loss, smoking cessation, moderation in fluid intake, elimination of foods that contain bladder irritants), bladder retraining and pelvic floor muscle exercises. These can be very effective and should be used in combination with drug therapy. They are discussed on this website under incontinence treatments. The book Overcoming Overactive Bladder by Newman and Wein has an excellent review of OAB treatments.

Drug Treatments for Overactive Bladder

Several types of medication are available for treating OAB and are classified as antimuscarinic (anticholinergic) drugs. Drugs used to treat OAB affect the nerve and muscle function of the detrusor (or bladder) muscle causing the detrusor muscle to relax, and thus reduce the frequency and intensity of contractions of the bladder and prevent the unwanted leakage of urine (urinary incontinence). They can also increase bladder capacity.

These drugs work by blocking the attachment of a neurotransmitter called acetylcholine to specific sites on the bladder muscle. The attachment of neurotransmitters to the receptors site (called cholinergic) sets in motion a sequence of changes that result in muscle contractions. Blocking this combination prevents the contraction. Because of these two actions, these drugs are called antimuscarinic or anticholinergic medication (they are the same thing).

The antimuscarinic drugs, oxybutynin and tolterodine, are the most widely used medications for OAB treatment and new drugs are being released to treat this disorder. Drugs used to treat OAB affect the nerve and muscle function of the bladder (detrusor muscle) making the muscle relax and thus reducing the frequency and intensity of contractions of the bladder. By decreasing bladder contractions, these drugs can decrease urinary frequency, urgency and "wetting" accidents. These drugs have been shown to work in 6 to 7 out of 10 persons. Persons should see an improvement in symptoms in 3 to 4 weeks. The incidence of adverse events, such as dry mouth, dry eyes, constipation and headache can occur with all of these medications.

Sometimes these drugs are prescribed together.

Tolterodine or Detrol

Tolterodine has been shown to improve OAB symptoms of urgency, urge urinary incontinence, and frequency. This drug comes in an immediate release form, Detrol 2 or 4 mg which is given twice a day or in an extended release pill that works over a 24 hour period. The most commonly prescribed medication is Detrol LA (long acting) 4 mg which is taken once a day.

Product and Website:

Product	Detrol (Tolteradine tartrate), Detrol LA
Manufacturer	Pfizer Inc.
Dosing	2 to 4 mg once daily
Administration	Oral tablets to be swallowed whole
Advantages	Long acting, extended release formulation, most prescribed medication for OAB
Disadvantages	Drinking extra fluids due to dry mouth may cause more frequent need to urinate.
Side Effects	Dry mouth, dry eye, headache, constipation, abdominal pain. In clinical tests, 2.4% of patients discontinued use due to side effects.

Oxybutynin

Oxybutynin, which has been extensively studied, is another drug used to treat OAB. The immediate release has been around for many years and is available in 2.5 or 5 mg, taken two, three, or four times a day. The extended release form, called Ditropan XL, is available in 5, 10 or 20 mg once a day. Usually your doctor or nurse will prescribe 5 mg and increase the dose to 10 mg, then higher depending on the effect the dose has on your OAB symptoms and the side effects that occur.

Another formulation of oxybutynin is Oxytrol which is a thin, clear and transparent patch that sticks to the skin. The patch delivers a daily dose of 3.9 mg of oxybutynin and is placed on the stomach, buttocks or thigh twice a week. The patch can cause some skin irritation such as redness and itching which can be treated with a moisturizing cream. To prevent these skin side effects, it is recommended that the patch be placed on a new site each time it is applied. A skin patch is felt to have fewer side effects because it avoids breakdown of the drug in the bowel and liver (called first pass metabolism).

Products and Websites:

Product	Ditropan XL (oxybutinin chloride)	Oxytrol
Manufacturer	Ortho-McNeil Pharmaceutical, Inc.	Watson Pharma Inc.
Dosing	Available in 3 strengths: 5-mg, 10-mg, and 15-mg tablets and can be used at doses up to 30 mg daily.	Each OXYTROL patch delivers 3.9 mg of oxybutynin per day.
Administration	Tablets must be swallowed whole with the aid of liquids, and must not be chewed, divided, or crushed.	Transdermal (skin patch) applied to the abdomen, hip or buttock twice weekly.
Advantages	Can provide relief in as early as 2 weeks	Bypasses metabolism in liver and stomach, provides continuous and consistent delivery of oxybutynin over a three to four day interval.
Disadvantages	Heat stroke and fever due to decreased sweating in hot temperatures have been reported.	Skin reactions at application site. Difficulty with altering dose.
Side Effects	Dry mouth, constipation, drowsiness, headache, blurred vision, dizziness, diarrhea, and nausea. In clinical tests, 6.8% of patients discontinued use due to side effects.	Low incidence of drying side effects such as dry mouth and constipation. In clinical tests, 11% of patients discontinued treatment due to adverse events — no patients discontinued due to dry mouth.

Sanctura

A recently FDA approved medication called trospium chloride is available as Sanctura 20 mg taken twice a day on an empty stomach or 1 hour before meals. Trospium is a non-selective antimuscarinic drug which appears to have fewer effects on the memory. It has a quick onset of action which means it works within a few hours. This drug has been shown to decrease the OAB symptoms of frequency both day and night, urgency, and urge-related wetting accidents.

Product and Website:

Product	Sanctura (trospium chloride)
Manufacturer	Esprit Pharmaceuticals, Inc. and Indevus Pharmaceuticals, Inc.
Dosing	20 mg twice daily
Administration	Oral, tablet taken one hour before meals or on an empty stomach.
Advantages	Reductions in symptoms experienced as early as one week into treatment, long period of use and clinical studies. No known drug-drug interactions.
Disadvantages	Drinking extra fluids due to dry mouth may cause more frequent need to urinate.
Side Effects	The most common adverse effects for SANCTURA vs placebo were dry mouth (20% vs 6%), constipation (10% vs 5%), and headache (4% vs 2%).

New drugs and methods of administration are currently being investigated in attempts to improve tolerability of treatments for OAB. Additional new drugs include:

Darifenacin (Enablex)

Product and website:

Product	Enablex (darifenacin)
Manufacturer	Novartis Pharmaceuticals Corporation
Dosing	7.5 mg or 15 mg once daily
Administration	Tablet taken with liquid and swallowed whole.
Advantages	May begin to relieve symptoms in as little as 2 weeks.
Disadvantages	Drinking extra fluids due to dry mouth may cause more frequent need to urinate.
Side Effects	Dry mouth, constipation, indigestion, and abdominal pain, blurred vision and heat prostration. The majority of side effects experienced by people taking ENABLEX were mild or moderate and most occurred during the first 2 weeks of treatment.

Solifenacin (Vesicare)

Product and website:

Product	Vesicare (solifenacin)
Manufacturer	Astellas Pharma US, Inc. and The GlaxoSmithKline Group of Companies
Dosing	5 mg or 10 mg once daily
Administration	Tablet taken with liquid and swallowed whole.
Advantages	Low incidence of side effects.
Disadvantages
Side Effects	Dry mouth, constipation, blurred vision, dyspepsia. In clinical tests, 2.8% of patients discontinued use due to adverse events.

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Posted December 2003
Updated March 2006