The combined medication approach for treating overactive bladder: assessing safety and efficacy

Research question: What is the latest evidence on the efficacy and safety of combining medications to treat overactive bladder? The problem: Overactive bladder symptoms negatively impact quality of life and, with an ageing population, overactive bladder prevalence is expected to rise. Current treatments do not adequately address all patients’ needs, with concerns about dementia risk from antimuscarinics, and not all patients wish to proceed to invasive procedures. This highlights the need for alternative pharmacological strategies. Literature review: The literature emphasises the detrimental impact of overactive bladder on patients’ daily lives and highlights safety concerns, particularly cognitive risks linked to traditional antimuscarinics. Methodology: Nine randomised controlled trials were critically appraised for methodological quality and risk of bias, with findings synthesised narratively due to study heterogeneity. Results: Explored combinations include beta-3 adrenoreceptor agonists (vibegron or mirabegron) with antimuscarinics, beta-3 adrenoreceptor agonists with phosphodiesterase 5 inhibitors, and antimuscarinics with cholinergic agonists. These combinations demonstrated improved efficacy and tolerability in treating overactive bladder while minimising side effects. Most studies report symptom improvement without increased cardiovascular risk. Conclusions: Combination therapies demonstrate superior efficacy compared to monotherapy without increasing anticholinergic burden, offering promising treatment alternatives. These findings support the expansion of new agents (vibegron) and novel pharmacological combinations in nursing practice to improve patient outcomes while considering safety profiles. However, methodological limitations such as sample bias and potential funding bias should be noted.