The clinical pharmacology of the medical treatment for overactive bladder in adults

ABSTRACT

Introduction

Overactive bladder is a prevalent symptom complex that affects the patient’s quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium.

Areas covered

In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB.

Expert opinion

OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.

KEYWORDS:

• Pharmacotherapy
• overactive bladder
• medical treatment
• antimuscarinics
• β-adrenoceptor agonists
• botulinum toxin-A

Article highlights

• OAB is a multifactorial condition patient often has more than a single complaint.

• Antimuscarinics are more effective than placebo in improving OAB.

• There are no statistically significant differences between the different antimuscarinics in improving OAB.

• Antimuscarinics are often accompanied by adverse events that result in treatment discontinuation.

• The rate of continuation mirabegron compared with antimuscarinics is promising and can be an alternative treatment.

• The ideas of using low or high dosages, flexible dosages, and stopping or changing the medication totally depend on the effectiveness of the treatment and patient satisfaction.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer declaration

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was supported by the Student Research Committee (Grant No. 63765) of Tabriz University of Medical Sciences and approved by the local ethical committee of Tabriz University of Medical Sciences (IR.TBZMED.VCR.REC.1398.280).