What’s the Best Medication for Overactive Bladder?

You may recognize the signs of overactive bladder (OAB), especially if you're one of the 33 million U.S. adults who are all-too-familiar with it. The thought of needing to go to the bathroom suddenly without warning can control how you move about your day. It may even cause feelings of anxiety.

If you have OAB and aren’t sure why, you may want to pay a visit to your healthcare provider. OAB can have a variety of causes, some of which are simple to diagnose and treat. You could, for example, have a urinary tract infection (UTI) that can be treated with antibiotics to relieve your symptoms.

No matter the cause, not having control over your bladder can be both frustrating and disruptive. But you’re in luck — OAB can often be treated through lifestyle changes such as diet, pelvic floor exercises (Kegels), and bladder training. But, when needed, medications are also there for you to use. 

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In fact, both over-the-counter (OTC) and prescription medications are available that can provide relief. Let's dive into which bladder control medications may be best for you.

Over-the-counter overactive bladder medications

Many OTC medications and supplements are marketed for OAB. But not all of them are FDA-approved. Read along to see which OAB products are available to you without a prescription.

Herbal supplements

At one point, the CDC pointed out that up to 75% of people living with OAB take herbal supplements for symptomatic relief. Popular herbal supplements for OAB include: 

• Gosha-jinki-gan (GJG)

• Hachi-mi-jio-gan (HE)

• Buchu (Barosma betuline)

• Cleavers (Galium aparine)

• Cornsilk (Zea mays)

• Horsetail (Equisetum)

However, no herbal supplements have been approved or widely recommended to treat OAB. Because there is limited research, we can't say for sure if herbal remedies work. There’s also a chance that they could interact with other medications that you may be taking. 

Make sure to ask your healthcare provider if herbal supplements like these are OK for you to take.

Oxytrol patch

There is a medication patch available that’s FDA-approved to treat OAB. It’s available OTC to treat OAB in women as Oxytrol for Women. And, it’s available as a prescription-only version for men as Oxytrol. In both Oxytrol for Women and Oxytrol, the active ingredient in the patch is oxybutynin. 

Oxybutynin is an anticholinergic medication that has a “drying” effect, so it can help keep your bladder in check. Once applied, Oxytrol for Women and Oxytrol patches will last for 4 days then it needs to be replaced. Only one patch should be applied at a time.

Side effects from Oxytrol can include mild redness or itching where the patch is applied. It can also cause other common anticholinergic side effects, such as dry mouth. But because Oxytrol patches have limited absorption, anticholinergic side effects are typically less common than its oral counterpart. We’ll discuss anticholinergic side effects more below.

Prescription overactive bladder medications

If you find that lifestyle changes Oxytrol patches are ineffective, don't worry. There are a number of FDA-approved medications that can help you manage your symptoms. 

Anticholinergics

Anticholinergics are a group of medications that work by blocking a chemical in your body called acetylcholine. Acetylcholine normally tells your bladder muscles to contract, causing you to urinate. Blocking this chemical helps control your bladder contractions.

Commonly prescribed oral anticholinergics for OAB include:

• Oxybutynin (Ditropan)

• Tolterodine (Detrol, Detrol LA)

• Fesoterodine (Toviaz)

• Trospium

• Solifenacin (Vesicare)

• Darifenacin (Enablex)

When medications are needed, oral anticholinergics are a first-choice treatment. Some anticholinergics are also available as extended-release (ER) formulations. This means the medication is released gradually over time. If an ER formulation is available, it’s usually preferred because it has a smaller risk of side effects, especially dry mouth. 

Talk to your healthcare provider to see which formulation may be best for you.

Beta-3 adrenergic agonists

Beta-3 adrenergic agonists are a group of medications that work by activating receptors (chemical binding sites) in your bladder. They relax your bladder and allow it to hold more urine.

The two beta-3 adrenergic agonists available to treat OAB are mirabegron (Myrbetriq) and vibegron (Gemtesa).

In addition to anticholinergic medications, beta-3 adrenergic agonists are another possible first-choice treatment option. And because they work differently than anticholinergics, they can be taken together as a combination therapy in severe cases of OAB.

Is there a best medication for overactive bladder?

The prescription options are comparable to each other. The differences that make one better than the other are due to factors like side effects, cost, and other medical conditions you may have. We’ll discuss this more below.

Side effects of overactive bladder medications

While anticholinergics and beta-3 adrenergic agonists are helpful options for people with OAB, they can cause side effects. 

Anticholinergics

The most common side effects of anticholinergics are:

• Dry mouth

• Constipation

• Drowsiness

• Blurry vision

• Nausea

Anticholinergics have also been associated with a higher risk of dementia. For this reason, it’s recommended that anticholinergics be avoided in older adults if possible.

Beta-3 adrenergic agonists

The most common side effects of beta-3 adrenergic agonists are:

• Elevated blood pressure

• Constipation

• Inability to empty your bladder

• UTIs

• Dry mouth

• Sinus irritation

• Headache

• Dizziness

Although both groups of medications may cause dry mouth, beta-3 adrenergic agonists carry a lower risk of it. Also, keep in mind that the risk of these side effects is dependent on the dose of medication.

Overactive bladder medication precautions

OAB medications aren’t right for everyone. People with the following health conditions should talk to their healthcare provider and take caution before using medications for OAB:

• If you experience heart palpitations, irregular heart rhythms, or other electrical heart issues, it’s important to use medications with caution. Two OAB medications — solifenacin and tolterodine — cause QT prolongation which can worsen these symptoms. However, the ER formulation of tolterodine carries less risk of heart complications. 

• If you have kidney problems, you’ll likely have to take lower doses of trospium, tolterodine, fesoterodine, or solifenacin.

• If you have liver problems, you’ll need to take a lower dose of darifenacin, solifenacin, or tolterodine. Fesoterodine shouldn’t be taken at all if you have severe liver problems.

• If you live with glaucoma, urinary retention, or a gastrointestinal condition, you should avoid all anticholinergic medications in most cases.

How to save on overactive bladder medications

There are many ways to save on your overactive bladder medications. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs.

Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Toviaz at an exclusive cash price of $200.10. You can also find generic overactive bladder medications for as low as $9 per month with a free GoodRx discount.

Why trust our experts?

Written by:

Sheila McAdoo, PharmD

Sheila McAdoo, PharmD, is a licensed pharmacist in Virginia, New York, and the District of Columbia. She has worked in the pharmacy industry for 12 years and currently works as a community pharmacist.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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