Overactive Bladder & Urinary Incontinence Treatments

OVERACTIVE BLADDER & URINARY INCONTINENCE TREATMENTS
Generic	Brand	Strength	Form	Dose
ANTICHOLINERGIC
imipramine HCl	—	10mg, 25mg, 50mg	tabs	<6yrs: Not established. ≥6yrs: Childhood enuresis: Initially 25mg daily 1hr before bedtime; after 1wk, increase to 50mg for children 6−12yrs, up to 75mg if >12yrs. Early night bedwetters: Give 25mg in afternoon and repeat at bedtime. Max 2.5mg/kg/day.
ANTISPASMODIC/ANTICHOLINERGIC
oxybutynin chloride	—	5 mg	scored tabs	<5yrs: Not recommended. ≥5yrs: 5mg twice daily; max 15mg/day Adults: 5mg 2−3 times a day; max 20mg/day
		5mg/ 5mL	syrup
		5mg, 10mg	ext-rel tabs	<6yrs: Not recommended. ≥6yrs: Initially 5mg once daily; may increase in 5mg increments; max 20mg/day. Adults: Initially 5mg or 10mg once daily; may increase weekly in 5mg increments; max 30mg/day.
oxybutynin transdermal system	Oxytrol	3.9mg/ day	patch	Children: Not established. Adults: Apply 1 patch twice weekly (every 3−4 days) to clean, dry area on the abdomen, hip or buttock. Rotate application sites.
BETA-3 ADRENERGIC AGONIST
mirabegron	Myrbetriq	25mg, 50mg	ext-rel tabs	Children: <3yrs: Not established. Neurogenic detrusor overactivity: ≥3yrs (≥35kg): Initially 25mg once daily; may increase to max 50mg once daily after 4–8wks if needed. Adults: Initially 25mg once daily; may increase to 50mg once daily after 4–8wks if needed. Severe renal impairment or moderate hepatic impairment: max 25mg once daily.
mirabegron	Myrbetriq Granules	8mg/mL	ext-rel oral susp after reconstitution	Children: <3yrs: Not established. Measure and dissolve granules with 100mL of water. Take with food once daily. Neurogenic detrusor overactivity: ≥3yrs: (11–<22kg): Initially 3mL (24mg), max 6mL (48mg); (22–<35kg): Initially 4mL (32mg), max 8mL (64mg); (≥35kg): Initially 6mL (48mg), may increase to max 10mL (80mg) after 4–8wks if needed. Severe renal impairment or moderate hepatic impairment: (11–<22kg): max 3mL (24mg); (22–<35kg): max 4mL (32mg); (≥35kg): max 6mL (48mg). Adults: Not indicated.
vibegron	Gemtesa	75mg	tabs	Children: Not established. Adults: 75mg once daily.
MUSCARINIC ANTAGONIST
darifenacin HBr	—	7.5mg, 15mg	ext-rel tabs	Children: Not established. Adults: Initially 7.5mg once daily; may increase to 15mg once daily after 2wks. Moderate hepatic impairment (Child-Pugh B), concomitant potent CYP3A4 inhibitors: max 7.5mg once daily.
fesoterodine fumarate	Toviaz	4mg, 8mg	ext-rel tabs	Children: <6yrs or ≤25kg: Not established. Neurogenic detrusor overactivity: ≥6yrs: (>25–35kg): 4mg once daily, may increase to 8mg once daily if needed; (>35kg): initially 4mg once daily, then increase to 8mg once daily after 1wk. Mild to moderate renal impairment (eGFR 30–89mL/min/1.73m²): (>25–35kg): max 4mg/day; (>35kg): no change (same as above). Severe renal impairment (eGFR 15–29mL/min/1.73m²) or concomitant strong CYP3A4 inhibitors: (>25–35kg): not recommended; (>35kg): max 4mg/day. Adults: 4mg once daily; may increase to max 8mg once daily. Severe renal impairment (CrCl <30mL/min) or concomitant potent CYP3A4 inhibitors: max 4mg/day.
solifenacin succinate	Vesicare	5mg, 10mg	tabs	Children: Not established. Adults: Initially 5mg once daily; if well tolerated, may increase to 10mg once daily. Severe renal impairment (CrCl<30mL/min), moderate hepatic impairment, or concomitant potent CYP3A4 inhibitors (eg, ketoconazole): max 5mg once daily.
solifenacin succinate	Vesicare LS	1mg/mL	oral susp	Children: <2yrs: Not established.Take once daily, followed by liquid (eg, water or milk). ≥2yrs: 9–15kg: initially 2mL (max 4mL); >15–30kg: initially 3mL (max 5mL); >30–45kg: initially 3mL (max 6mL); >45–60kg: initially 4mL (max 8mL); >60kg: initially 5mL (max 10mL). Severe renal impairment (CrCl <30mL/min/1.73m²), moderate hepatic impairment (Child-Pugh B), or concomitant strong CYP3A4 inhibitors: do not exceed the recommended initial dose. Adults: Use other form.
tolterodine tartrate	Detrol	1mg, 2mg	tabs	Children: Not established. Adults: 2mg twice daily; may decrease to 1mg twice daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 1mg twice daily.
tolterodine tartrate	Detrol LA	2mg, 4mg	ext-rel caps	Children: Not established. Adults: 4mg once daily; may decrease to 2mg once daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 2mg once daily.
trospium chloride	—	20mg	tabs	Children: Not established. Adults: 20mg twice daily. ≥75yrs: 20mg once daily if twice daily dose not tolerated. Severe renal impairment (CrCl<30mL/min): 20mg once daily at bedtime.
trospium chloride	—	60mg	ext-rel caps	Children: Not established. Adults: 60mg daily in the AM. Severe renal impairment (CrCl<30mL/min): not recommended.
NEUROMUSCULAR BLOCKER
onabotuli– numtoxin A	Botox	50 U/vial, 100 U/vial, 200 U/vial	vacuum-dried pwd; for intra–detrusor inj after reconsti– tution and dilution	Children: <5yrs: Not established. Neurogenic detrusor overactivity: ≥5yrs: (<34kg): 6 Units/kg; (≥34kg): 200 Units/treatment. Give 20 injections of 0.5mL each into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. May consider re-treatment after effect of the previous injection diminishes but no sooner than 12wks. Adults: Overactive bladder: Max dose: 100 Units/treatment; give 20 injections of 0.5mL each into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. Detrusor overactivity: Max dose: 200 Units/treatment, give 30 injections of 1mL (~6.7 Units) each into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. Both: may consider re-treatment after effect of the previous injection diminishes but no sooner than 12wks. Max cumulative dose: 400 Units in a 3-month interval.
VASOPRESSIN (SYNTHETIC)
desmopressin acetate	DDAVP	0.1mg, 0.2mg	scored tabs	<6yrs: Not recommended. ≥6yrs: Nocturnal enuresis: individualize. Initially 0.2mg once daily at bedtime; max 0.6mg.
NOTES
Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 2/2024)

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