Drugs for Overactive Bladder

Background

The seven prescription drugs used to treat overactive bladder are only modestly effective and have side effects that can limit their usefulness. If you have mild symptoms, first try lifestyle changes (for example, cutting back on caffeinated beverages) and other nondrug steps, such as Kegel exercises to strengthen pelvic muscles that help control urination, to see if those provide enough relief. People with more severe symptoms can also benefit from those steps, but might experience added relief from also taking medication.

To help you and your doctor choose the right overactive bladder drug if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, side effects, safety, and cost. To learn more and to see a longer report on the topic, please visit CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Overactive Bladder Drug?

An overactive bladder makes you urinate suddenly, and you may leak urine (incontinence). You usually urinate eight or more times a day, and a few times at night. Overactive bladder can be caused by weakness in the muscle that controls the flow of urine. Treatment can ease your symptoms and improve your quality of life.

Talk to your doctor for a correct diagnosis. There are some similar conditions that need different treatments:

• Stress incontinence: Coughing, running, or laughing cause urination.
• Overflow incontinence: You can’t urinate fully. Something may be blocking the flow.

Other conditions can cause similar symptoms, including diabetes, urinary-tract infections, kidney stones, and prostate problems. Some medicines can increase urination—such as diuretics used to treat high blood pressure.

Nondrug treatments can help a lot.

• With “bladder training,” you learn to urinate at regular times. You practice holding your urine for longer and longer periods.
• Kegel exercises strengthen the muscles that control the flow of urine.
• Lifestyle changes can help. Cut back on caffeine and alcohol. Drink fewer liquids between dinner and bedtime.

Your doctor may recommend that you also try a medicine if your symptoms are severe—for example, if you urinate 15 or more times a day, or leak urine several times a day.

Strengths and Weaknesses of These Drugs

Generic Name

Brand Name

Strengths

Weaknesses

Oxybutynin tablet

(short-acting)

Generic only

  • On the market longest, well-known by doctors
  • Many studies confirm its effectiveness

  • Highest rate of side effects, including dry mouth and constipation
  • More people report severe dry mouth compared with other drugs
  • Need to take 2 to 3 pills a day

Oxybutynin tablet

(extended release)

Ditropan XL

  • Lower rate of side effects than short-acting oxybutynin
  • Needs to be taken just once a day

  • More expensive than the short-acting form

Oxybutynin

transdermal patch

Oxytrol

  • Available over-the-counter
  • No need to take a pill
  • Patch is changed every three to four days
  • Lower rate of dry mouth compared with oxybutynin pill

  • Irritation at site of patch is common; can be severe

Oxybutynin

topical gel

Gelnique

  • No need to take a pill
  • Gel is applied to abdomen, arm, or thigh daily

  • Very limited research to date

Tolterodine

(short-acting)

Detrol

  • Fewer patients report dry mouth or constipation than with oxybutynin short-acting

  • Taken twice a day (may be an advantage over oxybutynin tablets, but a disadvantage compared with daily Detrol LA)

Tolterodine

(extended-release)

Detrol LA

  • Taken once a day
  • Fewer side effects compared with oxybutynin and short-acting Detrol

Trospium

(short-acting)

Sanctura

  • Lower rate of severe dry mouth than with oxybutynin

Trospium

(extended-release)

Sanctura XR

  • Taken once a day

  • Very limited research to date

Solifenacin

Vesicare

  • Taken once a day
  • Improves some symptoms better than Detrol or Detrol LA
  • Lower rate of dry mouth than with Detrol

  • Higher rates of dry mouth and constipation than with Detrol LA

Mirabegron

Myrbetriq

  • Taken once a day
  • Doesn’t cause mental confusion
  • Poses less risk of blurred vision and dry mouth

  • Newest drug; less research on effectiveness and safety than other drugs
  • No evidence directly comparing it to other drugs
  • May cause high blood pressure

Darifenacin

Enablex

  • Taken once a day
  • Lower rate of overall side effects, dry mouth, and severe dry mouth than with oxybutynin

Fesoterodine

Toviaz

  • Improved some symptoms better than Detrol LA

  • More likely to cause dry mouth and lead to withdrawal from studies due to side effects

Our Recommendations

Try nondrug treatments first. If they don’t help enough, talk with your doctor about also taking an overactive bladder drug. One drug, the Oxytrol patch, is sold over-the-counter. Before you try it, talk to your doctor and get a proper diagnosis.

We compared how well the different drugs work to reduce symptoms. The main differences were in side effects and costs. We chose the following as Consumer Reports Best Buy Drugs to treat overactive bladder—if you and your doctor decide that a drug is worth trying:

Tolterodine is our Best Buy pick because it has fewer side effects. To save on costs, you can try the generic oxybutynin first. The side effects are not a problem for everyone.

Cost Comparison

Note: If the price box contains a

, that indicates the dose of that drug may be available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Generic Name and Dose*

Brand Name(s)1

Frequency of Use Per Day2

Average Monthly Cost 3

Darifenacin 7.5 mg

Enablex

One

$219

Darifenacin 15 mg

Enablex

One

$208

Fesoterodine 4 mg

Toviaz

One

$199

Fesoterodine 8 mg

Toviaz

One

$199

Mirabegron 25 mg tablets

Myrbetriq

One

$240

Mirabegron 50 mg tablets

Myrbetriq

One

$246

Oxybutynin 5 mg

Generic

Two

$24

Oxybutynin 5 mg

Generic

Three

$36

Oxybutynin extended-release 5 mg tablets

Generic

One

$72

Oxybutynin extended-release 10 mg tablets

Ditropan XL

One

$173

Oxybutynin extended-release 10 mg tablets

Generic

One

$71

Oxybutynin extended-release 15 mg tablets

Ditropan XL

One

$205

Oxybutynin extended-release 15 mg tablets

Generic

One

$73

Oxybutynin skin patch 3.9 mg/24 hrs

Oxytrol

New patch every 3-4 days

$374

Oxybutynin skin patch 3.9 mg/24 hrs

Oxytrol for Women (OTC)

New patch every 3-4 days

NA4

Oxybutynin topical gel 10%

Gelnique

Apply once daily

$244

Solifenacin 5 mg tablets

Vesicare

One

$231

Solifenacin 10 mg tablets

Vesicare

One

$232

Tolterodine 1 mg tablets

Generic

Two

$183

Tolterodine 2 mg tablets

Detrol

Two

$294

Tolterodine 2 mg tablets

Generic

Two

$167

Tolterodine extended-release 2 mg capsules

Detrol LA

One

$255

Tolterodine extended-release 4 mg capsules

Detrol LA

One

$231

Trospium 20 mg tablets

Generic

Two

$150

Trospium 60 mg extended-release capsules

Sanctura XR

One

$228

Trospium 60 mg extended-release capsules

Generic

One

$191

*If a drug is not listed, that indicates it had less than 20 prescriptions per month, so we do not list it because the price is unreliable and
pharmacies might be unlikely to carry it due to low demand.

1. “Generic” means the price given is for the generic version.

2. As typically prescribed.

3. Prices reflect nationwide retail average for August 2013, rounded to the nearest dollar. Prices are derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

4. NA = Not available. The price for Oxytrol for Women patch was not available at the time of publication.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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