Mirabegron vs. Solifenacin: 7 Key Facts You've Wanted to Know
Navigating the treatment options for overactive bladder (OAB) can be overwhelming for both patients and healthcare providers. Among the various therapies, mirabegron and solifenacin stand out due to their effectiveness and established presence in the management of OAB. Here we’ll look at a clear comparison of these two medications—detailing how they work, their efficacy, potential side effects, and answering key questions about their use, including whether they can be taken in conjunction.
1. They Both Treat Overactive Bladder Symptoms
What is OAB?
Overactive bladder (OAB) is a syndrome characterized by the sudden, involuntary contraction of the muscle in the bladder wall, which leads to a frequent and urgent need to urinate, sometimes accompanied by incontinence. These symptoms can significantly impact a person's quality of life. Globally, an estimated 10-17% of people are affected by OAB, with similar prevalence in the United States, where about 33 million Americans live with the condition.
Mirabegron and Solifenacin for OAB
Mirabegron and solifenacin are both approved medications for treating symptoms of overactive bladder (OAB), such as urinary incontinence, urgency, and urinary frequency. Mirabegron is sold under the brand name Myrbetriq, while solifenacin is marketed as Vesicare.
In 2020, the sales of OAB products reached $2.2 billion across major markets. Myrbetriq is currently the leading therapy for OAB, accounting for over 50% of the global market share in 2020. Vesicare, the brand name for solifenacin, also plays a critical role in OAB management with its sales totaling hundreds of millions of dollars worldwide.
2. They Are Similar in Efficacy
Several clinical studies suggest that mirabegron and solifenacin are comparably effective in reducing the number of daily urgency episodes and micturition. For instance, a meta-analysis published in the Neurourology and Urodynamics concluded that mirabegron (50 mg) and solifenacin (5 mg) showed no significant difference in efficacy when analyzed across various randomized controlled trials for the treatment of OAB.
3. However, The Way They Treat OAB Is Different
How Mirabegron Works
Mirabegron, a beta-3 adrenergic receptor agonist, promotes relaxation of the detrusor smooth muscle during the storage phase, which increases bladder capacity and decreases the urgency and frequency of urination.
How Solifenacin Works
Solifenacin is a muscarinic receptor antagonist that blocks acetylcholine, which reduces the incidence of involuntary detrusor muscle contractions and increases bladder storage capacity.
Key Summary
- Mirabegron targets the sympathetic nervous system to relax the bladder, reducing urgency and frequency.
- Solifenacin affects the parasympathetic nervous system, inhibiting involuntary contractions and potentially offering more control over urination.
4. Optimal Timing for Dosing: Morning or Evening?
The administration of these medications is typically once daily. The optimal timing for your dose can be tailored to your individual symptoms, factoring in the medications' pharmacokinetics for best effect. [1, 2]
- If you experience pronounced urgency and frequency during the day, taking the medication in the morning may offer greater relief.
- Conversely, if you find night-time symptoms to be more of a concern, an evening dose could be more advantageous.
5. What Are Their Side Effects?
Some known common side effects include:
- Increased blood pressure
- Headache
- Urinary Tract Infection
- Pain or Swelling of the Nose or Throat
- Dry mouth
- Headache
- Urinary Retention
- Constipation
Patients may prefer one over the other based on their personal tolerance to these side effects and their specific medical needs.
6. Can You Switch From One to Another?
Yes, switching between mirabegron and solifenacin may be possible and even beneficial in some cases. Studies suggest that patients who do not respond to or cannot tolerate one medication may find relief with an alternative. For example, a prospective study in Journal of the Formosan Medical Association concluded that switching from solifenacin to mirabegron can be effective and safe for OAB patients who are refractory to solifenacin treatment.
The transition should be managed by a healthcare provider to ensure safety and optimize treatment outcomes.
7. Can You Use Mirabegron and Solifenacin Together?
Yes, combining mirabegron and solifenacin may be considered when a single drug, or monotherapy, does not adequately control OAB symptoms.
Studies have explored the efficacy and safety of using both medications concurrently. A multinational phase III study showed that combined therapy with solifenacin and mirabegron provided consistent improvements in efficacy compared with the respective monotherapies across most of the outcome parameters. However, the potential for additive side effects, such as increased heart rate from mirabegron and urinary retention from solifenacin, must be closely monitored.
It is critical to note that dual therapy should only be pursued under the guidance of a healthcare professional who can assess the potential benefits and risks in the context of a patient’s individual health profile. The decision to initiate combination therapy should be based on symptom severity, response to prior treatments, and the presence of any comorbidities that may influence drug tolerability.
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