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<sup>1</sup> Urgency (sudden compelling desire to pass urine which is difficult to defer) is the hallmark sx of OAB. Hx: fluid intake, voids per day/night, diuretic/other med use, degree of bother, comorbid conditions, etc.<br><br>
<sup>2</sup> Acceptable sx control may require trials of multiple tx options [CP]. Persist w/ new tx for adequate trial to determine efficacy, tolerability; d/c tx if efficacy not demonstrated. Assemble combo tx methodically, adding new tx only when relative efficacy of preceding tx known [EO]. Appropriate duration: 8-12 wks for behavioral, 4-8 wks for pharmacologic tx.
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<sup>3</sup> Behavior tx (1st-line) [S/B] includes bladder training, bladder control strategies, PFMT, fluid mgmt. Behavioral tx may be combined w/ drug tx [C], including antimuscarinics or β3-adrenoceptor agonists (mirabegron). If inadequate sx control and/or unacceptable ADE w/ 1 antimuscarinic: manage constipation/dry mouth, modify dose, or try a different antimuscarinic or a β3-adrenoceptor agonist (mirabegron) [CP]. Before abandoning effective antimuscarinic tx: manage constipation, dry mouth, including bowel and fluid mgmt, dose modification or alternative antimuscarinic. [CP] If IR and ER formulations available, ER preferred d/t lower rates of dry mouth. [S/B]
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<sup>4</sup> If IR and ER formulations available, ER preferred d/t lower rates of dry mouth. [S/B]
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<sup>5</sup> Antimuscarinics (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium): don’t use if narrow-angle glaucoma (unless approved by pt’s ophthalmologist); use w/ extreme caution in pts w/ impaired gastric emptying or urinary retention hx [CP]; if PVR >250-300 mL, use w/ caution. If obstructive voiding sx appear on antimuscarinic tx, monitor PVR.
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<sup>6</sup> Before abandoning effective antimuscarinic tx: manage constipation, dry mouth, including bowel and fluid mgmt, dose modification or alternative antimuscarinic. [CP]
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<sup>7</sup> PVR: measure w/ US bladder scanner immediately post void; if US scanner not available, use urethral cath.
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<sup>8</sup> Available to women ≥18 yo w/o prescription.
<sup>2</sup> Acceptable sx control may require trials of multiple tx options [CP]. Persist w/ new tx for adequate trial to determine efficacy, tolerability; d/c tx if efficacy not demonstrated. Assemble combo tx methodically, adding new tx only when relative efficacy of preceding tx known [EO]. Appropriate duration: 8-12 wks for behavioral, 4-8 wks for pharmacologic tx.
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<sup>3</sup> Behavior tx (1st-line) [S/B] includes bladder training, bladder control strategies, PFMT, fluid mgmt. Behavioral tx may be combined w/ drug tx [C], including antimuscarinics or β3-adrenoceptor agonists (mirabegron). If inadequate sx control and/or unacceptable ADE w/ 1 antimuscarinic: manage constipation/dry mouth, modify dose, or try a different antimuscarinic or a β3-adrenoceptor agonist (mirabegron) [CP]. Before abandoning effective antimuscarinic tx: manage constipation, dry mouth, including bowel and fluid mgmt, dose modification or alternative antimuscarinic. [CP] If IR and ER formulations available, ER preferred d/t lower rates of dry mouth. [S/B]
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<sup>4</sup> If IR and ER formulations available, ER preferred d/t lower rates of dry mouth. [S/B]
<br><br>
<sup>5</sup> Antimuscarinics (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium): don’t use if narrow-angle glaucoma (unless approved by pt’s ophthalmologist); use w/ extreme caution in pts w/ impaired gastric emptying or urinary retention hx [CP]; if PVR >250-300 mL, use w/ caution. If obstructive voiding sx appear on antimuscarinic tx, monitor PVR.
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<sup>6</sup> Before abandoning effective antimuscarinic tx: manage constipation, dry mouth, including bowel and fluid mgmt, dose modification or alternative antimuscarinic. [CP]
<br><br>
<sup>7</sup> PVR: measure w/ US bladder scanner immediately post void; if US scanner not available, use urethral cath.
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<sup>8</sup> Available to women ≥18 yo w/o prescription.
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