Table 3.

Drugs for treatment of OAB; characteristic, dosage, side effects, contraindications, and special precautions

Generic name	Drug classification	Brand name	Common dosage	Significant adverse reactions	Contraindications	Special precautions
Fesoterodine	anticholinergic agent	Toviaz	oral: 4 mg once daily, may be increased to 8 mg once daily	gastrointestinal: xerostomia (19–35%), constipation (4–6%)	hypersensitivity, urinary retention, gastric retention; heat prostration: environmental or exercise.	not recommended for patients with severely impaired renal or hepatic function; patients taking strong CYP3A4 inhibitors; elderly with dementia, delirium, pregnancy risk factor C; lactation not recommended.
Oxybutynin	antispasmodic agent, urinary	Ditropan XL Gelnique Oxytrol Uromax	oral: immediate release: 5 mg 2–3 times daily; maximum: 5 mg 4 times daily. extended release: initial: 5–10 mg once daily, adjust dose in 5 mg increments at weekly intervals; maximum: 30 mg once daily topical gel: Gelnique 3%: apply 3 pumps (84 mg) once daily; Gelnique 10%: apply contents of 1 sachet (100 mg/g) once daily. transdermal: apply one 3.9 mg/day patch twice weekly (every 3–4 days)	oral: central nervous system: dizziness (4–17%), drowsiness (2–14%) gastrointestinal: xerostomia (29–71%), constipation (7–15%), nausea/diarrhea (2–12) central nervous system: headache (6–10%), nervousness (1–7%), pain (1–7%), insomnia (1–6%) genitourinary: urinary hesitancy (1–9%), urinary tract infection (5–7%), urinary retention (1–6%), ophthalmic: blurred vision (1–10%), topical gel: gastrointestinal: xerostomia (2–12%) local: application site reaction (4–14%)	hypersensitivity, uncontrolled narrow-angle glaucoma, urinary retention, gastric retention or conditions with severely decreased gastrointestinal motility	not recommended for patients with severely impaired renal or hepatic function; elderly with dementia, delirium; pregnancy risk factor B; lactation: caution should be used if administered to a nursing woman. Suppression of lactation has been reported.
Solifenacin	anticholinergic agent	Vesicare	oral: 5 mg once daily, if tolerated, may increase to 10 mg once daily geriatric: base dosing on renal/hepatic function	gastrointestinal: xerostomia (11–28%), constipation (5–13%)	hypersensitivity; urinary retention; gastric retention; uncontrolled narrow-angle glaucoma.	not recommended for patients with severely impaired renal or hepatic function; patients taking strong CYP3A4 inhibitors; elderly with dementia, delirium; pregnancy risk factor C; lactation not recommended.
Tolterodine	anticholinergic agent	Detrol Unidet	oral: immediate release tablet: 2 mg twice daily, the dose may be lowered to 1 mg twice daily based on individual response and tolerability extended release capsule: 4 mg once daily	gastrointestinal: dry mouth (35%; extended release capsules 23%) central nervous system: headache (7%; extended release capsules 6%) gastrointestinal: constipation (7%; extended release capsules 6%)	hypersensitivity to tolterodine or fesoterodine urinary retention; gastric retention; uncontrolled narrow-angle glaucoma	not recommended for patients with severely impaired renal or hepatic function; dosing adjustment in patients concurrently taking strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir); pregnancy risk factor C; lactation not recommended.
Trospium	anticholinergic agent	Sanctura Trosec	oral: immediate release: 20 mg twice daily extended release: 60 mg once daily	gastrointestinal: xerostomia (9–22%), constipation (9–10%), central nervous system: headache (4–7%) genitourinary: urinary tract infection (1–7%)	hypersensitivity urinary retention; gastric retention; uncontrolled narrow-angle glaucoma	not recommended for patients with severely impaired renal or hepatic function; medications eliminated by active tubular secretion (ATS): ATS is a route of elimination; use caution with other medications that are eliminated by ATS (procainamide, pancuronium, vancomycin, morphine, metformin, and tenofovir); effects with other sedative drugs or ethanol may be potentiated; pregnancy risk factor C lactation with caution.
Darifenacin	anticholinergic agent	Enablex	oral: initial: 7.5 mg once daily. If there is no response after 2 weeks, dosage may be increased to 15 mg once daily	gastrointestinal: xerostomia (19–35%), constipation (15–21%). central nervous system: headache (7%)	hypersensitivity; uncontrolled narrow-angle glaucoma; urinary retention, paralytic ileus, gastrointestinal or urinary obstruction	not recommended for patients with severely impaired renal or hepatic function; patients taking strong CYP3A4 inhibitors; elderly with dementia, delirium; pregnancy risk factor C; lactation with caution.
Mirabegron	beta3 agonist	Myrbetriq	oral: initial: 25 mg once daily; efficacy is observed within 8 weeks for 25 mg dose. May increase to 50 mg once daily.	cardiovascular: hypertension (9–11%)	hypersensitivity, severe uncontrolled hypertension	not recommended for patients with severely impaired renal or hepatic function; limit mirabegron to 25 mg once daily in patients receiving concomitant CYP2D6 substrates with a narrow therapeutic index (flecainide, propafenone, thioridazine). pregnancy risk factor C lactation with caution.
Botulinum neurotoxin	botulinum neurotoxin	BoNT-A is the serotype most commonly used for treatment of lower urinary tract dysfunction. BoNT-A toxinonabotulinumtoxinA (Botox) or abobotulinumtoxinA	intra-detrusor injection: onabotulinumtoxin A range from 25 to 300 U abobotulinumtoxin A range from 250 to 1000 U	in high dosage or systemic spread possible muscle weakness, respiratory depression (rare).	peripheral motor neuropathy, neuromuscular junction disorders, treatment by medications that interfere with neuromuscular transmission (aminoglycosides, curare-like compounds neuromuscular blocking agents)