One of the most common ways to treat overactive bladder (OAB) is by using medication. You should talk to your doctor about your options and ask questions about the benefits and possible side effects of overactive bladder drugs.
Anticholinergics help treat overactive bladder by affecting the nerve function of the bladder muscle (detrusor) to relax. This helps reduce urinary urgency. Anticholinergics are commonly taken orally or applied as a patch or topical gel. There are different dosages to help with different severities of OAB. Some can be taken multiple times daily or a couple times a week. The patch form can be placed on the abdomen, stomach, or buttocks. A few examples are below:
- darifenacin (Enablex)
- fesoterodine (Toviaz)
- flavoxate (Urispas)
- oxybutynin (Ditropan, Gelnique, Oxytrol, Urotrol)
- solifenacin (Vesicare)
- tolterodine (Detrol)
- trospium (Sanctura)
Side effects may vary, but it is very common for these medications to cause dry mouth. Other potential side effects include dry eyes or throat, constipation, blurred vision, and increased heart rate.
Imipramine, a tricyclic antidepressant, is sometimes prescribed for OAB because it can help relax the smooth muscle of the bladder and cause the bladder neck to contract. Imipramine has been approved by the FDA for other uses, but not for the treatment of OAB.
Duloxetine (Cymbalta) is another antidepressant drug used to treat symptoms of OAB. It is approved for this purpose in Europe, but not in the United States. Nevertheless, this selective serotonin-norepinephrine reuptake inhibitor (SNRI) drug is often prescribed off-label for the treatment of stress urinary incontinence and overactive bladder.
Botulinum Toxin Type A (Botox)
Recent studies have shown that Botox injections into the bladder can significantly decrease OAB symptoms and can also improve bladder capacity and the ability to empty the bladder. Research varies as to the dosage and duration of relief, but the findings are promising for those who do not respond to anticholinergics. The FDA has not approved Botox, for incontinence.
Beta 3 Agonists
Until recently, there had been no new medications for the treatment of OAB in more than three decades. That changed in 2012, with FDA’s approval of mirabegron (Myrbetriq) for the treatment of OAB symptoms. Technically known as a beta-3 adrenergic agonist, this drug targets specific receptors on the smooth muscle of the urinary bladder (the detrusor). By reducing muscle contractions, the drug promotes greater retention of urine in the bladder, and reduces symptoms such as urinary urgency, frequency, nighttime urination, and incontinence. Side effects include possible increases in blood pressure.
These drugs are prescribed to improve urine flow in men with benign prostatic hyperplasia (BPH). Although many symptoms of BPH resemble the symptoms of overactive bladder, BPH symptoms are caused by an enlarged prostate gland, which may restrict the flow of urine through the urethra. Examples of alpha-blocker drugs include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral) and silodosin (Rapaflo). Some doctors may prescribe both an alpha-blocker and an antimuscarinic drug for their patients with BPH who are suffering from urinary complaints.
Desmopressin is a drug that successfully alleviates symptoms of nocturia; the urge to rise one or more time per night to void urine. The drug works by reducing the volume of urine produced by the kidneys. It is a synthetic version of a natural hormone, arginine vasopressin (also called antidiuretic hormone), which acts to suppress the production of urine in the kidneys by decreasing the amount of water that is extracted from the circulation.