Guess what? All of them work just as well. The differences which make one better than the other are in other areas: cost, side effects, and medical conditions you may have.
Here is what you need to know about the medications we prescribe for urinary incontinence and overactive bladder (OAB).
- Show me the money. The cost and coverage will depend on your medical plan and whether you are prescribed a generic. The cost will vary quite a bit . . . a ton actually.
- Sale price. Three of the OAB meds are generics so they will be much cheaper: these are oxybutynin (Ditropan), tolterodine (Detrol) and trospium (Sanctura).
- Over the counter?! The oxybutynin transdermal patch (Oxytrol for Women) is available over the counter for the treatment of overactive bladder in women (not men). It has not been tested in men.
- Pay up. The brand name OAB meds will be more expensive. These include Enablex (darifenacin), Toviaz (fesoterodine) and Vesicare (solifenacin).
- Bouncy heart. If you are someone who gets palpitations, atrial fibrillation, or has other electrical heart issues, two of these meds cause QT prolongation which can worsen that. Vesicare and tolterodine (Detrol) may cause electrical issues with the heart.
- Kidneys. If you have kidney disease or your kidneys don’t work great you will have to take lower doses of trospium (Sanctura), tolterodine (Detrol) or Vesicare (solifenacin), but the other choices don’t have to be modified.
- Liver. If you have liver disease you need to be on a lower dose of Enablex, Vesicare or Detrol (tolterodine)
- Medication interactions. If you are on many medications know this: trospium (Sanctura) is not metabolized by the CYP enzyme unlike the others and thus carries a low risk of interactions. Good to know.
- Dry mouth. The transdermal oxybutynin patch available over the counter carries by far the lowest risk of dry mouth.
- Constipation. You haven’t pooped in days or you have to strain to have a bowel movement so you’ll wonder if your medications are to blame. Maybe, and this will occur more often with Vesicare (solifenacin) and Enablex (darifenacin) than with the other options listed above.
- Too hot. Heat stroke and exertional heat illness occur more often with Vesicare, Enablex and oxybutynin (Ditropan). While this seems like a small thing, if you are visiting the Grand Canyon in the summer it is not.