Myrbetriq for Urinary Incontinence . . . Is It Worth the Price?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Less than 5% of women who experience urinary incontinence see their doctor about it, and when they do it takes over a year to get there. Urinary incontinence (UI) affects as many as 47% of older women so you are not alone, and should not be embarrassed. Although men and women can have UI, it is far more common in women.

Behavioral changes are the place for start for the symptoms of overactive bladder and UI. Pelvic floor physical therapy, weight loss, and eliminating caffeine, nicotine and spicy foods all help, but if your doctor thinks its time to turn to medications, here is what you need to know.

First line therapies for urge incontinence include medications known as anticholinergic medications. These include Detrol LA, Ditropan XL, Enablex, Toviaz, and Vesicare. Those medications all have comparable efficacy toward relieving symptoms of urgency, frequency, and urge incontinence, but there are substantial differences in their side effect profiles.

What if those medications give me constipation or a dry mouth? Well then, there is Myrbetriq (mirabegron). For those of you who experience intolerable adverse effects you can switch to a non anticholinergic and that is Myrbetriq. Myrbetriq relaxes the muscle that controls the bladder outlet and increases bladder capacity.

Does Myrbetriq work? Yep. It’s been shown to reduce the number of incontinence episodes, and it works as well as the anticholinergics (listed above) and leads to a 20% increase in bladder capacity. Myrbetriq comes in two doses and can be used alone or in combination with another medication for UI.

What’s the downside of Myrbetriq? Cost is a big one. It’s expensive and very rarely covered by insurance even when a prior authorization is attempted (trust me, I’ve tried for patients). The most common side effects are high blood pressure, dry mouth, constipation, headache and urinary tract infection.

Anyone tried it?

Dr O.

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