Anticholinergics and β-3 Agonists
ANTICHOLINERGICS
GENERAL CONTRAINDICATIONS
History of urinary retention, gastric retention (gastroparesis), uncontrolled narrow-angle glaucoma and should be used carefully if reduced renal or hepatic dysfunction.
Solifenacin succinate
INDICATIONS
CONTRAINDICATIONS
Contraindicated in patients with urinary retention, gastric retention, ileus or small bowel obstruction, uncontrolled narrow-angle glaucoma and should be used carefully if reduced renal or hepatic dysfunction. >5mg solifenacin not recommended in patients with severe renal impairment, moderate hepatic impairment, or when administered with ketoconazole or other potent CYP3A4 inhibitors.
DOSAGE
SIDE EFFECTS
Urinary retention, delayed gastric emptying, constipation
STUDIES
One study found exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia (1)
β-3 Agonists
Mirabegron (Myrbetriq)
INDICATION
CONTRAINDICATION
Myrbetriq is not recommended for use in severe uncontrolled hypertensive patients (defined as systolic blood pressure ≥ 180mm Hg and/or diastolic blood pressure ≥ 110mm Hg). Caution with CYP2D6 inihbitors
DOSAGE
SIDE EFFECTS
Myrbetriq alone or in combination with solifenacin succinate can increase blood pressure. Can cause urinary retention and is a CYP2D6 inhibitor. CYP2D6 substrates such as metoprolol and desipramine are increased when co‐administered with Myrbetriq. One study found pilocarbine was safely used to treat dry mouth from anticholinergics. (1)
GENERAL CONTRAINDICATIONS
History of urinary retention, gastric retention (gastroparesis), uncontrolled narrow-angle glaucoma and should be used carefully if reduced renal or hepatic dysfunction.
Solifenacin succinate
INDICATIONS
CONTRAINDICATIONS
Contraindicated in patients with urinary retention, gastric retention, ileus or small bowel obstruction, uncontrolled narrow-angle glaucoma and should be used carefully if reduced renal or hepatic dysfunction. >5mg solifenacin not recommended in patients with severe renal impairment, moderate hepatic impairment, or when administered with ketoconazole or other potent CYP3A4 inhibitors.
DOSAGE
SIDE EFFECTS
Urinary retention, delayed gastric emptying, constipation
STUDIES
One study found exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia (1)
β-3 Agonists
Mirabegron (Myrbetriq)
INDICATION
CONTRAINDICATION
Myrbetriq is not recommended for use in severe uncontrolled hypertensive patients (defined as systolic blood pressure ≥ 180mm Hg and/or diastolic blood pressure ≥ 110mm Hg). Caution with CYP2D6 inihbitors
DOSAGE
SIDE EFFECTS
Myrbetriq alone or in combination with solifenacin succinate can increase blood pressure. Can cause urinary retention and is a CYP2D6 inhibitor. CYP2D6 substrates such as metoprolol and desipramine are increased when co‐administered with Myrbetriq. One study found pilocarbine was safely used to treat dry mouth from anticholinergics. (1)
- Coupland, Carol A. C., et al. “Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study.” JAMA Internal Medicine, vol. 179, no. 8, 2019, pp. 1084–1093.
- Ko, Kwang Jin, et al. “Efficacy and Safety of Tolterodine and Pilocarpine in Patients with Overactive Bladder.” The Journal of Urology, vol. 202, no. 3, 2019, pp. 564–573.