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Myrbetriq vs Toviaz
Introduction
For patients coping with overactive bladder (OAB), certain drugs that influence the muscle contractions of the bladder can help in managing its symptoms, such as frequent urination and urinary incontinence. Myrbetriq and Toviaz are two such drugs prescribed for this condition. They each impact different receptors involved in bladder control but both have effects to decrease urgency, frequency, and instances of leakage in patients with OAB. Myrbetriq is a beta-3 adrenergic agonist, which works by relaxing the smooth muscle during filling phase to accommodate larger volumes of urine without increasing pressure. On the other hand, Toviaz is classified as an antimuscarinic drug specifically it’s a M3 receptor antagonist that blocks detrusor muscle contractions during bladder filling phase thereby reducing urgency.
What is Myrbetriq?
Mirabegron (the generic name for Myrbetriq) was the first drug of the class known as beta-3 adrenergic agonists, which marked a significant advancement from the previous class of drugs used to treat overactive bladder (OAB), known as antimuscarinics. Mirabegron was first approved by the FDA in 2012. Myrbetriq works by relaxing the detrusor muscle during urine storage phase, thereby increasing bladder capacity and reducing urinary urgency and frequency. It is prescribed primarily for patients suffering from OAB with symptoms such as increased urination frequency, urgent need to urinate, and inability to control urination. Myrbetriq specifically targets beta-3 receptors located in the bladder with minimal effect on other areas of body which results in it having fewer side effects than other medications that have stronger impacts on these non-targeted areas.
What conditions is Myrbetriq approved to treat?
Myrbetriq is approved for the treatment of various urinary disorders:
- Overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- Neurogenic detrusor overactivity (NDO), a type of bladder dysfunction related to nerve damage, often due to conditions like spinal cord injury or multiple sclerosis. This approval is specifically for pediatric patients aged 3 years and older.
How does Myrbetriq help with these illnesses?
Myrbetriq helps to manage symptoms of overactive bladder by relaxing the bladder muscle during the storage phase, thus increasing its capacity. It does this by stimulating beta-3 adrenergic receptors, which leads to relaxation of the detrusor smooth muscle in the wall of the bladder. This process can increase bladder capacity and reduce urgency. Overactive bladder is a condition characterized by an urgent need to urinate, frequent urination, and sometimes incontinence. The stimulation of beta-3 adrenergic receptors that Myrbetriq provides can limit these symptoms and help patients better manage their condition.
What is Toviaz?
Toviaz, known generically as fesoterodine, is part of a class of medications called antimuscarinics or anticholinergics. It works by blocking muscarinic receptors in the bladder and urinary tract to control overactive bladder symptoms such as frequent urination, urgency, and incontinence. Fesoterodine was first approved by the FDA in 2008.
Unlike Myrbetriq (mirabegron), which targets beta-3 adrenergic receptors to relax the detrusor muscle in the bladder wall and increase its storage capacity, Toviaz directly inhibits involuntary detrusor contractions without stimulating urine production.
One particular advantage of Toviaz compared to other medications used for overactive bladder is that it does not significantly affect salivary flow – a common side effect that can lead to dry mouth with many other similar drugs. However, potential side effects can include dry eyes and constipation.
What conditions is Toviaz approved to treat?
Toviaz is an antimuscarinic medication approved by the FDA for treating symptoms associated with:
- Overactive bladder (OAB) which can lead to a strong need to urinate right away, urinary incontinence, and frequent urination
- Urge urinary incontinence, where there's an intense sudden urge to urinate followed by unintentional loss of urine.
How does Toviaz help with these illnesses?
Toviaz, also known as fesoterodine, is a medication that works by blocking the action of acetylcholine, a neurotransmitter involved in many functions including muscle movement and bladder control. Acetylcholine plays a crucial role in regulating both voluntary and involuntary muscle contractions. Overactive bladder syndrome (OAB), which includes symptoms like frequent urination, urgency to urinate and urinary incontinence can result from an imbalance or overactivity of this neurotransmitter. Toviaz helps manage these symptoms by reducing the activity of acetylcholine on the muscles lining the bladder wall thereby increasing its capacity to hold urine and reducing urgency episodes. While Myrbetriq takes an alternative approach by relaxing the bladder smooth muscles through beta-3 adrenergic receptor agonism hence promoting storage of urine, Toviaz provides another effective option for patients who might not respond well to it or need combination therapy for managing their OAB symptoms.
How effective are both Myrbetriq and Toviaz?
Both Mirabegron (Myrbetriq) and Fesoterodine (Toviaz) have been approved by the FDA for managing overactive bladder (OAB), a condition characterized by increased frequency and urgency of urination, along with incontinence. These two drugs were approved three years apart, Myrbetriq in 2012 and Toviaz in 2008. They work on different pathways to control OAB symptoms; Myrbetriq is a beta-3 adrenergic agonist that relaxes the bladder muscle during urine storage phase, whereas Toviaz is an antimuscarinic agent that reduces involuntary contractions of the bladder.
The effectiveness of both medications was compared directly in several double-blind clinical trials. In these studies, both Myrbetriq and Toviaz showed similar efficacy for reducing episodes of urinary incontinence as well as increasing voiding intervals.
A systematic review published in 2016 highlighted that fesoterodine has been shown to be effective from the first week of treatment. Its side effect profile includes common anticholinergic effects such as dry mouth and constipation but it was generally well-tolerated across various populations including elderly patients. The recommended dose varies between 4 mg/day up to 8mg/day depending upon individual patient tolerance levels.
Similarly, according to a meta-analysis conducted in 2017, mirabegron appears more effective than placebo at treating OAB symptoms without many commonly associated anticholinergic side effects like dry mouth or constipation which may occur with other treatments for this condition. Further research suggests its efficacy can be enhanced when used alongside an antimuscarinic drug if monotherapy does not provide sufficient relief.
At what dose is Myrbetriq typically prescribed?
Oral dosages of Myrbetriq range from 25-50 mg/day, but clinical studies suggest that 25 mg/day is sufficient for treating overactive bladder in most adults. There's no recommended usage for children under the age of 18 years old. For adult patients, dosage can be increased to a maximum of 50 mg/day after several weeks if symptoms have not improved sufficiently. Toviaz, on the other hand, has an oral dosage ranging from 4-8mg per day; with research indicating that a starting dose of 4mg daily is effectual for many individuals suffering from overactive bladder syndrome as well. If needed and tolerated by the patient, this dose can be increased to a maximum of 8mg daily after at least two weeks.
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At what dose is Toviaz typically prescribed?
Toviaz treatment is typically initiated at a dosage of 4 mg/day taken orally once daily. Depending on the patient's response and tolerability, the dose can then be increased to 8 mg/day after a week if necessary. It should not exceed this maximum dose per day. The tablet should be swallowed whole without chewing, breaking or crushing it, and can be taken with or without food. Always remember that any changes in dosages should always under medical supervision to avoid adverse effects or complications from occurring.
What are the most common side effects for Myrbetriq?
Common side effects of Myrbetriq may include:
- Increased blood pressure
- Common cold symptoms (nasopharyngitis)
- Urinary tract infection
- Headache
- Dry mouth
On the other hand, common side effects of Toviaz can include:
- Dry mouth
- Constipation
- Dry eyes
- Trouble emptying your bladder completely.
Remember, while these lists highlight some possible side effects, they are not exhaustive. Always consult with a healthcare provider for full information and guidance when considering a new medication.
Are there any potential serious side effects for Myrbetriq?
In some rare instances, Myrbetriq can cause severe side effects, which include:
- Allergic reactions such as hives, difficulty breathing or swallowing
- Accumulation of fluid retention in the legs, feet or ankles leading to swelling
- Increased blood pressure which could lead to headaches, dizziness and a rapid heartbeat
- Painful urination or inability to empty your bladder (urinary retention)
- Severe kidney problems - characterized by changes in the amount of urine passed
- Liver problems – symptoms may include nausea, loss of appetite and yellowing of skin or eyes
On the other hand, Toviaz is also generally safe but potential serious side effects can occur. They are:
- Trouble emptying your bladder
- Reduced saliva production causing dry mouth potentially leading to tooth decay over long-term use
- Constipation and gastric issues such as gastroesophageal reflux disease (GERD) due to slowed digestion
- Blurred vision; eye pain or redness; seeing halos around lights
For both drugs it's crucial that if you experience any above mentioned problematic symptoms immediately consult with a healthcare professional.
What are the most common side effects for Toviaz?
Toviaz, a medication used to treat overactive bladder symptoms, can potentially cause the following side effects:
- Dry mouth and eyes
- Blurred vision
- Constipation
- Dizziness or headache
- Sleep disturbances such as trouble sleeping (insomnia)
- Nausea or stomach upset
- Tiredness or fatigue
It's also important to note that while less common, some people may experience more serious side effects like fast or irregular heartbeat. As with any medication, it is crucial to discuss these potential side effects with your health care provider before starting treatment.
Are there any potential serious side effects for Toviaz?
Toviaz is generally a safe medication, but like all drugs, it can sometimes have severe side effects. It's important to be aware of these potential risks and monitor for symptoms such as:
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat.
- Severe stomach pain or constipation
- Painful or difficult urination
- Little or no urinating
- Dry mouth with thirst and headache, followed by weakness and dizziness
- Blurred vision, tunnel vision, eye pain, seeing halos around lights
- Fast heart rate If you experience any of the above side effects after taking Toviaz, seek immediate medical attention.
Contraindications for Myrbetriq and Toviaz?
Both Myrbetriq and Toviaz, along with most other medications for overactive bladder, may worsen symptoms of urinary or bladder problems in some people. If you notice your symptoms worsening, such as more frequent urination or inability to control urination, please seek immediate medical attention.
Neither Myrbetriq nor Toviaz can be taken if you are taking drugs known as anticholinergics. Always tell your physician which medications you are taking; these will need a period of about 5 days to clear from the system to prevent dangerous interactions with Myrbetriq and Toviaz.
Also note that both drugs can cause side effects like dry mouth, constipation, blurred vision and dizziness. In case these conditions persist or become severe ensure to inform your doctor promptly.
How much do Myrbetriq and Toviaz cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Myrbetriq (50 mg) averages around $400, which works out to approximately $13.33/day.
- The price for 30 extended-release capsules of Toviaz (8 mg) is roughly $330, which comes to about $11/day.
Thus, if you are prescribed the higher dosage range for Myrbetriq (i.e., 50 mg per day), then brand-name Toviaz is less expensive on a per-day treatment basis. However, it's important to note that cost should not be your main consideration when deciding which drug is right for you.
As for generic versions of both medications - currently, there are no generic alternatives available in the U.S. market due to patent regulations. This means prices remain relatively high and stable with little competition among manufacturers.
Popularity of Myrbetriq and Toviaz
Mirabegron, available under the brand name Myrbetriq, has emerged as a popular medication for overactive bladder symptoms. According to data from 2020, Myrbetriq was prescribed to an estimated 1.9 million people in the United States, accounting for about 35% of medications specifically targeting overactive bladder.
Fesoterodine, sold under the brand name Toviaz, is another drug aimed at treating overactive bladder. In 2020 it was prescribed to approximately 600 thousand individuals in the U.S., making up around 11% of prescriptions for this condition.
While both drugs have been increasing in prevalence since their respective market introductions (Myrbetriq in 2012 and Toviaz in late-2008), Mirabegron's prescription numbers have seen a more significant rise compared to Fesoterodine's relatively steady rate. Essential differences between these two are their mechanisms of action: while both reduce muscle spasms of the bladder and urinary tract - Mirabegron works by relaxing these muscles whereas Fesoterodine reduces unwanted contractions.
Conclusion
Both Myrbetriq (mirabegron) and Toviaz (fesoterodine) are well-established medications used to manage the symptoms of overactive bladder. They have been shown in numerous clinical studies and meta-analyses to be more effective than placebo treatments at reducing urinary urgency, frequency, and incontinence. Occasionally, both drugs may be used together but this should only be done under close supervision by a physician due to potential drug interactions.
Myrbetriq works primarily by relaxing the bladder muscle during storage phase, thus increasing its capacity, whereas Toviaz inhibits involuntary contractions of the bladder by blocking specific receptors (muscarinic receptors). Therefore they might be chosen for different patient profiles depending on their particular symptoms or comorbidities.
Both Myrbetriq and Toviaz are available as generic medicines which can represent significant cost savings for patients paying out-of-pocket. Both may require some time before full benefits are observed.
The side effects between these two drugs differ somewhat; common side effects with Myrbetriq include hypertension, headache and nasopharyngitis while those with Toviaz include dry mouth and constipation. However generally speaking both drugs are considered safe when taken as directed though patients must report any unusual symptom immediately to a healthcare professional.
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Refrences
- Tzefos, M., Dolder, C., & Olin, J. L. (2009, November 17). Formulary Forum: Fesoterodine for the Treatment of Overactive Bladder. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1m308
- Bridgeman, M. B., Friia, N. J., Taft, C., & Shah, M. (2013, June 11). Mirabegron: β<sub>3</sub>-Adrenergic Receptor Agonist for the Treatment of Overactive Bladder. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1s054
- Thiagamoorthy, G., Cardozo, L., & Robinson, D. (2016, June 2). Current and future pharmacotherapy for treating overactive bladder. Expert Opinion on Pharmacotherapy. Informa UK Limited.http://doi.org/10.1080/14656566.2016.1186645
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- Santos‐Silva, A., da Silva, C. M., & Cruz, F. (2013, May 2). Botulinum toxin treatment for bladder dysfunction. International Journal of Urology. Wiley.http://doi.org/10.1111/iju.12188
- Mansfield, K. (2009, December). Role of fesoterodine in the treatment of overactive bladder. Research and Reports in Urology. Informa UK Limited.http://doi.org/10.2147/rru.s5171
- Keam, S. J. (2021, May 31). Mirabegron: Pediatric First Approval. Pediatric Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40272-021-00452-4