Combination Therapy for Overactive Bladder

Clinical Approach

• The American Urological Association (AUA) and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guidelines recommend adding a medication with a different mechanism of action, such as mirabegron, to patients who experience inadequate symptom control with solifenacin alone 1
• The AUA/SUFU guidelines suggest that β3-adrenoceptor agonists, like mirabegron, can be added to antimuscarinic medications, such as solifenacin, when patients do not experience adequate efficacy 1
• Combination therapy should be considered for patients with inadequate symptom control with solifenacin alone, or when dose escalation of solifenacin is not tolerated due to side effects 1

Monitoring and Precautions

• Regular blood pressure monitoring is recommended when initiating mirabegron, especially during the initial treatment period 2
• Mirabegron is contraindicated in patients with severe uncontrolled hypertension 2
• Caution should be exercised when prescribing this combination to frail elderly patients, as they may have a lower therapeutic index and higher adverse event profile 1, 2
• Behavioral strategies, including prompted voiding and fluid management, may be helpful for patients who cannot tolerate pharmacologic management 1