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overactive bladder (OAB) medications and non-drug treatments

by Diane K. Newman, DNP, FAAN, BCB-PMD

Overactive bladder (OAB) medications and non-drug therapies may reduce symptoms and improve bladder control.  

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Overactive bladder treatments may include basic behavioral and lifestyle changes to control OAB symptoms.

Behavioral techniques, which improve bladder control by teaching persons to adopt new skills, are recommended first for treating overactive bladder (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 non-drug treatments can be very effective and should be used in combination with drug therapy. They are discussed on this website under incontinence treatments

Overactive Bladder (OAB) Medications

Several types of medication are available for treating overactive bladder (OAB) and are classified as antimuscarinic (anticholinergic) drugs. Drugs used to treat overactive bladder 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 overactive bladder treatment and new drugs are being released to treat this disorder. Drugs used to treat overactive bladder 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 who 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 for Overactive Bladder (OAB)

Tolterodine has been shown to improve overactive bladder 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 for Overactive Bladder (OAB)

Oxybutynin, which has been extensively studied, is another drug used to treat overactive bladder. 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 overactive bladder 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.
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Sanctura for Overactive BLadder (OAB)

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 overactive bladder 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 overactive bladder. Additional new drugs include:
 

Darifenacin (Enablex) for Overactive Bladder (OAB)

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) for Overactive Bladder (OAB)

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 August 2009
  

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