Management of Worsening Incontinence with Gemtesa (Vibegron)

Alternative Treatment Options

The American College of Physicians recommends switching to mirabegron, which has a different molecular structure, when Gemtesa (vibegron) worsens incontinence, with moderate-quality evidence showing mirabegron achieves continence more effectively than placebo (NNTB, 12) 1
Mirabegron improves urinary incontinence compared with placebo (NNTB, 9), according to the American College of Physicians 1
The American Urological Association suggests that mirabegron has fewer drug interactions than antimuscarinic medications 3
The American Geriatrics Society notes that mirabegron has a lower risk of cognitive effects, particularly important for elderly patients 3

High-quality evidence shows solifenacin achieves continence more than placebo (NNTB, 9), as recommended by the American College of Physicians 1
The American Urological Association states that solifenacin has the lowest risk for discontinuation due to adverse effects among antimuscarinics 3
Moderate-quality evidence shows fesoterodine achieves continence more than tolterodine (NNTB, 18), according to the American College of Physicians 1
High-quality evidence shows fesoterodine improves UI more than tolterodine, as noted by the American College of Physicians 1
The American College of Physicians recommends tolterodine as an option, with high-quality evidence showing it achieves continence (NNTB, 12) and improves UI (NNTB, 10) more than placebo 1

The Journal of Urology reports that solifenacin/mirabegron combination therapy showed superior results to monotherapy for reducing incontinence episodes 4
The American College of Obstetricians and Gynecologists suggests that intravaginal estrogen plus pelvic floor muscle training (PFMT) is more effective than estrogen alone for achieving continence in postmenopausal women 5, 1

The American Urological Association recommends assessing for side effects like constipation, dry mouth, and cognitive changes with antimuscarinic medications 3
The American College of Physicians suggests considering non-pharmacological approaches alongside medication changes, including bladder training, pelvic floor muscle training, and fluid management and caffeine reduction 3