Names and pronunciation
(mir′a-beg′ron) Myrbetriq
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Drug reference
(mir′a-beg′ron) Myrbetriq
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Func. class.: Bladder antispasmodic
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Chem. class.: β3-Adrenergic receptor agonist
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ACTION: Relaxes smooth muscles in urinary tract, increase bladder capacity
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USES: Overactive bladder (urinary fre- quency, urgency), urinary incontinence
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeed- ing, children, kidney/liver disease, bladder obstruction, dialysis, hypertension
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SIDE EFFECTS CNS: Fatigue, dizziness, headache CV: Hypertension, tachycardia EENT: Xerophthalmia, blurred vision GI: Anorexia, abdominal pain, constipa- tion, diarrhea, nausea, vomiting GU: Urinary retention, frequency, UTI, bladder discomfort INTEG: Stevens-Johnson syndrome, rash, pruritis MS: Arthralgia, back pain
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INTERACTIONS Increase: effect of CYP2D6 substrates Increase: effect of digoxin, warfarin, desipramine Increase: mirabegron effect—CYP3A4 inhibitors Increase: urinary retention risk—antimus- carinic agents (atropine, scopolamine) Drug/Lab Test Increase: LFTs, digoxin, INR, LDH
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DOSAGE AND ROUTES Overactive bladder • Adult: PO 25 mg/day, may increase to 50 mg/day if needed, may be given with solifenacin Hepatic/renal dose • Adult: PO Child-Pugh B or CCr 15-29 mL/min, max 25 mg/day; Child-Pugh C or CCr <15 mL/min, not recommended
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Available forms: Tabs ext rel 25, 50 mg
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Administer: • Give whole; take with liquids; do not crush, chew, or break ext rel product; use without regard to meals • Missed dose should not be taken; take at next selected time
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Assess: • Urinary patterns: distention, nocturia, frequency, urgency, incontinence • Angioedema (rare): swelling of face, lips, tongue, dyspnea; discontinue im- mediately, have emergency equipment nearby • LFTs at baseline, periodically • Monitor B/P, pulse often • Pregnancy/breastfeeding: use only if benefits outweigh risks to fetus; no well- controlled studies, discontinue product, not known if excreted in breast milk
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Evaluate: • Decreasing dysuria, frequency, noctu- ria, incontinence
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CLINICAL CONSIDERATIONS M
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Patient and caregiver information: • Hypertension: to report fast heartbeat; monitor B/P, P at home • Angioedema (rare): to report immedi- ately swelling of face, lips, tongue • To avoid hazardous activities; dizziness can occur; may take up to 8 wk for full effect • Not to drink liquids before bedtime • About the importance of bladder maintenance • Not to breastfeed; to report if preg- nancy is planned or suspected • Not to crush, chew, split; to take with- out regard to food, not to skip, double doses, if missed take at regularly sched- uled next day, provide “Patient Informa- tion Materials” • To discuss all OTC, Rx, herbals, sup- plements with provider
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PHARMACOKINETICS 71% protein binding, excretion 25% unchanged in urine, half-life 50 hr, peak 3.5 hr
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• Adult: PO 25 mg/day, may increase to 50 mg/day if needed, may be given with solifenacin Hepatic/renal dose
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• Adult: PO Child-Pugh B or CCr 15-29 mL/min, max 25 mg/day; Child-Pugh C or CCr <15 mL/min, not recommended
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