mirabegron

(redirected from Myrbetriq)

mirabegron

(mye-ra-beg-ron) ,

Myrbetriq

(trade name)

Classification

Therapeutic: urinary tract antispasmodics
Pharmacologic: beta adrenergic agonists
Pregnancy Category: C

Indications

Treatment of symptoms of overactive bladder (OAB) including urge urinary incontinence, urgency, and frequency.

Action

Acts as a selective beta-3 adrenergic agonist.
Increases bladder capacity by relaxing detusor smooth muscle during storage phase of bladder fill-void cycle.

Therapeutic effects

Decreased symptoms of OAB.

Pharmacokinetics

Absorption: 29–35% absorbed following oral administration.
Distribution: Widely distributed.
Metabolism and Excretion: Extensively metabolized, 6% excreted unchanged in urine (25 mg dose), remainder excreted in urine and feces as metabolites.
Half-life: 50 hr.

Time/action profile (effects on bladder)

ROUTEONSETPEAKDURATION
POunknown3.5 hr†24 hr
†Blood level.

Contraindications/Precautions

Contraindicated in: Severe uncontrolled hypertension; Lactation: Probably enters breast milk and may cause adverse reactions in infant;End-stage renal disease or severe hepatic impairment (Child-Pugh Class C).
Use Cautiously in: Hypertension;Bladder outlet obstruction/concurrent antimuscarics (↑ risk of urinary retention);Concurrent use of antimuscarinics used to treat OAB; Obstetric: Use only potential maternal benefit outwieghs risk to patient/fetus; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • nasopharyngitis

Cardiovascular

  • ↑ BP
  • tachycardia

Gastrointestinal

  • constipation
  • diarrhea
  • nausea

Genitourinary

  • urinary tract infection

Interactions

Drug-Drug interaction

Acts as a moderate inhibitor of the CYP2D6 enzyme system.May ↑ levels and risk of adverse reactions of drugs metabolized by the the CYP2D6 enzyme system including desipramine, flecainide, metoprolol, propafenone, and thioridazine clinical/blood level monitoring recommended.May ↑ levels and risk of toxicity with digoxin (use lowest effective level of digoxin/monitor serum levels).

Route/Dosage

Oral (Adults) 25 mg once daily initially is usually effective within 8 wk, may be ↑ to 50 mg once daily based on need/tolerance.

Renal Impairment

Oral (Adults) Severe renal impairment (CCr15–20 mL/min)—dose should not exceed 25 mg/day.

Hepatic Impairment

Oral (Adults) Moderate hepatic impairment (Child-Pugh Class B)—dose should not exceed 25 mg/day.

Availability

Extended-release tablets: 25 mg, 50 mg

Nursing implications

Nursing assessment

  • Assess patient for urinary urgency, frequency, and urge incontinence periodically during therapy.
  • Monitor BP prior to starting and periodically during therapy; may cause ↑ BP.

Potential Nursing Diagnoses

Impaired urinary elimination (Indications)
Urinary retention (Indications)

Implementation

  • Oral: Administer without regard to food.
    • Swallow tablets whole with water; do not break, crush, or chew.

Patient/Family Teaching

  • Instruct patient to take mirabegron as directed. If a dose is missed, omit dose and begin taking next day; do not take 2 doses on the same day. Advise patient to read Patient Information sheet prior to starting and with each Rx refill in case of changes.
  • Inform patient that mirabegron may cause an increase in BP. Advise patient to have BP checked periodically during therapy.
  • May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to notify health care professional if difficulty emptying bladder occurs.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decreased urinary frequency, urgency, and urge incontinence.
References in periodicals archive ?
The analyst cites his conviction for a positive readout in patients with overactive bladder based on the approval of vibegron in Japan and also points to Astellas' Myrbetriq, which is a drug from the same class as that of Urovant, being commercially available in the U.S.
In the US, mirabegron and solifenacin succinate are marketed as Myrbetriq and VESIcare, respectively.
Astellas Pharma US lnc.'s overactive bladder medication Myrbetriq (mirabegron) is the sponsor for the company's Keep on Dancing Sweepstakes launched earlier this month.
Side effects can include cognitive impairment, dry eye, dry mouth and constipation, leading some 80 percent of people to quit the medications.A newer treatment called Myrbetriq, which is a type of medication called a beta-agonist, aims to avoid the side effects.
Compared with the 2012 AUA/SUFU recommendations, the 2014 guideline on "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults" adds the beta3-adrenoceptor agonist mirabegron (Myrbetriq, Astellas Pharma) as a first- or second-line treatment option for some patients.
* In March Health Canada approved Astellas Pharma's Myrbetriq (mirabegron extended-release tablets).
Drugs that won FDA approval in 2012 include lorcaserin hydrochloride (Belviq) to treat overweight and obsesity, mirabegron (Myrbetriq) for overactive bladder, and linaclotide (Linzess) to treat idiopathic constipation and irritable bowel syndrome with constipation in adults.
Food & Drug Admin., FDA Approves Myrbetriq for Overactive Bladder (June 28, 2012), available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm310096.htm (reporting on the approval of a new drug to treat OAB).
Mirabegron and solifenacin succinate are already marketed in the United States as Myrbetriq and VESIcare, respectively.
Another medication, mirabegron (Myrbetriq), increases the bladder's capacity to hold more urine, but it can affect blood pressure.
The animal data for mirabegron (Myrbetriq; antispasmodic for overactive bladder) suggest low risk.