mirabegron

mye-ra-BEG-ron

Therapeutic Classification: urinary tract antispasmodics

Pharmacologic Classification: beta-adrenergic agonists

REMS

Overactive bladder, including urge urinary incontinence, urgency, and frequency (either as monotherapy or in combination with solifenacin).
Pediatric neurogenic detrusor overactivity.

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

Therapeutic effects:

Decreased symptoms of overactive bladder.
Improved bladder capacity in neurogenic detrusor overactivity.

Absorption: 29–35% absorbed following oral administration.

Distribution: Widely distributed.

Metabolism/Excretion: Extensively metabolized, 6% excreted unchanged in urine (25-mg dose); remainder excreted in urine and feces as metabolites.

Half-Life: Adults: 50 hr; Children: 26–31 hr.

(effects on bladder)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	3–4 hr‡	24 hr

‡Blood level.

Contraindicated in:

Hypersensitivity;
Severe uncontrolled hypertension;
End-stage renal disease (eGFR <15 mL/min/1.73 m² or requiring dialysis);
Severe hepatic impairment.

Use Cautiously in:

Hypertension;
Bladder outlet obstruction/concurrent antimuscarinics (↑ risk of urinary retention);
Concurrent use of antimuscarinics used to treat overactive bladder;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <3 yr (safety and effectiveness not established).

CV: ↑BP, tachycardia

EENT: nasopharyngitis

GI: constipation, diarrhea, nausea

GU: urinary tract infection

Neuro: dizziness, headache

Misc: ANGIOEDEMA

Drug-drug:

May ↑ levels and risk of toxicity of CYP2D6 substrates, including desipramine, flecainide, metoprolol, propafenone, and thioridazine.
May ↑ levels and risk of toxicity of digoxin; use lowest effective level of digoxin/monitor serum levels.

The extended-release tablets and extended-release oral suspension are NOT interchangeable and should NOT be combined.

Overactive Bladder

PO (Adults ): 25 mg once daily; may ↑ to 50 mg once daily, if needed, after 4–8 wk.

Renal Impairment

PO (Adults ): eGFR 15–29 mL/min/m²: 25 mg once daily (max dose = 25 mg/day).

Hepatic Impairment

PO (Adults ): Moderate hepatic impairment: 25 mg once daily (max dose = 25 mg/day).

Neurogenic Detrusor Overactivity

PO (Children ≥3 yr and ≥35 kg): Extended-release tablets: 25 mg once daily; may ↑ to 50 mg once daily, if needed, after 4–8 wk. Extended-release oral suspension (granules): 48 mg once daily; may ↑ to 80 mg once daily, if needed after 4–8 wk.
PO (Children ≥3 yr and 22–<35 kg): Extended-release oral suspension (granules): 32 mg once daily; may ↑ to 64 mg once daily, if needed after 4–8 wk.
PO (Children ≥3 yr and 11–<22 kg): Extended-release oral suspension (granules): 24 mg once daily; may ↑ to 48 mg once daily, if needed after 4–8 wk.

Renal Impairment

PO (Children ≥3 yr and ≥35 kg): eGFR 15–29 mL/min/m²: Extended-release tablets: 25 mg once daily (max dose = 25 mg/day); Extended-release oral suspension (granules): 48 mg once daily (max dose = 48 mg/day).

Renal Impairment

PO (Children ≥3 yr and 22–<35 kg): eGFR 15–29 mL/min/m²: Extended-release oral suspension (granules): 32 mg once daily (max dose = 32 mg/day).

Renal Impairment

PO (Children ≥3 yr and 11–<22 kg): eGFR 15–29 mL/min/m²: Extended-release oral suspension (granules): 24 mg once daily (max dose = 24 mg/day).

Hepatic Impairment

PO (Children ≥3 yr and ≥35 kg): Moderate hepatic impairment: Extended-release tablets: 25 mg once daily (max dose = 25 mg/day); Extended-release oral suspension (granules): 48 mg once daily (max dose = 48 mg/day).

Hepatic Impairment

PO (Children ≥3 yr and 22–<35 kg): Moderate hepatic impairment: Extended-release oral suspension (granules): 32 mg once daily (max dose = 32 mg/day).

Hepatic Impairment

PO (Children ≥3 yr and 11–<22 kg): Moderate hepatic impairment: Extended-release oral suspension (granules): 24 mg once daily (max dose = 24 mg/day).

(Generic available)

Extended-release tablets: 25 mg; 50 mg
Extended-release oral suspension (granules): 8 mg/mL

Assess for urinary urgency, frequency, urge incontinence, and urinary retention periodically during therapy.
Monitor BP prior to starting and periodically during therapy; may ↑ BP.
Monitor for signs and symptoms of angioedema (swelling of face, lips, tongue, or larynx). If airway symptoms occur, discontinue mirabegron and treat symptomatically.

Tablets and granules are different products. Do not interchange, substitute, or combine.
PO: Administer without regard to food.
- DNC: Swallow tablets whole with water; do not break, crush, or chew.
Pediatric patients weighing ≥35 kg may use tablets or granules.
Administer granules for patients weighing <35 kg. Prepare granules as an extended-release oral suspension. Tap the closed bottle to loosen granules. Add 100 mL of water to bottle, shake vigorously for 1 min, let stand for 10–30 min, and then shake again for 1 min. Repeat shaking for 1 min if granules have not dispersed. Take with food. Store at room temperature for ≤28 days after reconstitution.

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to take a missed dose as soon as remembered. If >12 hr since missed dose omit and take next dose at scheduled time.
Advise patient to have BP checked periodically during therapy to monitor for hypertension.
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 provider if difficulty emptying bladder occurs.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient to immediately discontinue mirabegron and notify health care provider if difficulty breathing or upper airway swelling occurs.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Decreased urinary frequency, urgency, and urge incontinence.

Myrbetriq

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆