# Overactive Bladder (Urge Incontinence) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559, Astellas Pharma Ltd): "The recommended dose is 5 mg solifenacin succinate once daily. If needed, the dose may be increased to 10 mg solifenacin succinate once daily." · Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) · eMC SmPC, Detrusitol XL 4 mg prolonged-release capsules (Viatris), sections 4.1 and 4.2 · EAU Guidelines on Non-neurogenic Male/Female LUTS 2023 · Mirabegron Astellas 50 mg prolonged-release tablets SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 7540) · Urge Incontinence - disease-level clinical article (urge-incontinence-full.txt) - Verified date: 2026-08 ## Verified against - Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559, Astellas Pharma Ltd): "The recommended dose is 5 mg solifenacin succinate once daily. If needed, the dose may be increased to 10 mg solifenacin succinate once daily." - Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) - Mirabegron Astellas 50 mg prolonged-release tablets SmPC sections 4.1-4.2 (eMC product 7540) - eMC SmPC, Detrusitol XL 4 mg prolonged-release capsules (Viatris), sections 4.1 and 4.2 - Urge Incontinence - disease-level clinical article (overactive-bladder-full.txt) ## Treatment metadata - Solifenacin succinate — 5 mg — oral.solid - Referral & safety-netting (no drug therapy) - Oxybutynin — 5 mg — oral.solid - Mirabegron — 50 mg — oral.solid - Tolterodine — 4 mg — oral.solid ## Complete treatment card ```text OVERACTIVE BLADDER (URGE INCONTINENCE) Sources: Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559, Astellas Pharma Ltd): "The recommended dose is 5 mg solifenacin succinate once daily. If needed, the dose may be increased to 10 mg solifenacin succinate once daily." · Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) · eMC SmPC, Detrusitol XL 4 mg prolonged- release capsules (Viatris), sections 4.1 and 4.2 · EAU Guidelines on Non-neurogenic Male/Female LUTS 2023 · Mirabegron Astellas 50 mg prolonged-release tablets SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 7540) · Urge Incontinence - disease-level clinical article (urge-incontinence-full.txt) Review status: REVIEWED against Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559, Astellas Pharma Ltd): "The recommended dose is 5 mg solifenacin succinate once daily. If needed, the dose may be increased to 10 mg solifenacin succinate once daily.", Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470), Mirabegron Astellas 50 mg prolonged-release tablets SmPC sections 4.1-4.2 (eMC product 7540), eMC SmPC, Detrusitol XL 4 mg prolonged-release capsules (Viatris), sections 4.1 and 4.2, Urge Incontinence - disease-level clinical article (overactive-bladder-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Urgency with typical daytime frequency and nocturia, without leakage on cough, sneeze, lifting, or position change, points to an urge-type pattern rather than stress incontinence [nocturia] - Episodes can be triggered by a sudden urge, coughing, sneezing, hearing running water, lifting, or changing position [cough · sneezing] - More than 7 voids in a day counts as increased urinary frequency worth asking about [urinary frequency] SIGNS - what you find (5) - A directed neurological and pelvic exam, plus gait and BMI assessment, helps look for an underlying cause of the bladder symptoms [overactive bladder] - A Valsalva manoeuvre held for more than 6 seconds and staying positive can reveal pelvic organ prolapse [genital prolapse] - A speculum exam may show vaginal atrophy, incontinence-related skin irritation, or a fistula causing urine loss outside the urethra [atrophy · fistula] - A positive cough stress test - immediate leakage with cough when the bladder holds at least 200 mL - is highly sensitive and specific for stress incontinence [cough · overactive bladder · urinary incontinence] - The cotton swab test is positive for urethral hypermobility when the swab's angle shifts more than 30 degrees from resting during straining TESTS (7) - Urinalysis with microscopy, and culture if needed, screens for blood, glucose, or infection as a cause of the urgency - A voiding diary records fluid intake, symptoms, and the situations that trigger urgency episodes - Postvoid residual assessed by ultrasound helps evaluate bladder emptying, especially with obstructive or neurological symptoms - Specialist referral is warranted for bladder pain, advanced prolapse, fistula, neurological symptoms, malignancy, prior urologic surgery, recurrent UTI, sterile pyuria, hematuria, or a post-void residual over 50 mL - A postvoid residual under 50 mL favours a diagnosis of urge incontinence - A postvoid residual should be measured with ultrasound rather than catheterisation, for better accuracy and less invasiveness - Urodynamic testing is warranted when the symptom scale, history, and voiding diary do not line up IF NOT THIS - what else fits (5) - OAB and urge incontinence are often used as if interchangeable, but most OAB cases have no actual leakage of urine - Diabetes mellitus is on the differential for the urgency and frequency symptoms - Recurrent UTI can produce similar urgency symptoms and should be on the differential - Neurological disease should be considered in the differential for urgency symptoms - Stress or mixed-type incontinence can be hard to distinguish from this on symptoms and history alone Source StatPearls "Urge Incontinence" - disease-level clinical article | merged with Urge Incontinence - disease-level clinical article (urge-incontinence-full.txt), ITEM 167 Status traced to the source above Rx: Main treatment | Beta-3 agonist for patients who cannot tolerate an antimuscarinic MAIN TREATMENT - choose one 1. SOLIFENACIN SUCCINATE [1st line] Adult 5 mg once daily, may be increased to 10 mg once daily if required - long-term Peds Not recommended for children and adolescents under 18 years Source Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559, Astellas Pharma Ltd): "The recommended dose is 5 mg solifenacin succinate once daily. If needed, the dose may be increased to 10 mg solifenacin succinate once daily." Why Solifenacin is a selective antimuscarinic that blocks M3 receptors on the detrusor muscle, relaxing the bladder to reduce urgency and frequency; it is a first-line pharmacologic option for overactive bladder per EAU guidance. Caution Anticholinergic effects include dry mouth, constipation, blurred vision, and urinary retention. CONTRAINDICATED in narrow-angle glaucoma, severe ulcerative colitis, and urinary retention; caution in elderly patients because of cognitive impairment and fall risk. Sudden-onset urge incontinence with neurological signs (leg weakness, saddle numbness, back pain) needs urgent assessment for a spinal cord cause, not this drug. Confirm bladder training and lifestyle measures have been tried, and rule out a urinary tract infection, before starting a drug. Egypt NANOFREQ 5 MG 20 F.C. TAB. MEPACO 37.25 EGP (1.86/unit) IMPRONACIN 5MG 10 F.C. TAB. BORG 25.20 EGP (2.52/unit) URGINAFECT 5 MG 20 F.C. TABS. FUTURE PHARMA... 72.00 EGP (3.60/unit) SLOWURGE 5 MG 30 F.C.TABS. MASH PREMIERE... 111.00 EGP (3.70/unit) SOLITRACT 5 MG 30 F.C. TAB. EVA PHARMA 117.00 EGP (3.90/unit) TORMEEL 5 MG 30 F.C. TAB. EUROPEAN EGYP... 126.00 EGP (4.20/unit) SOFENACIN 5MG 30 F.C. TAB. MARCYRL PHARM... 141.00 EGP (4.70/unit) VESICARE 5 MG 30 F.C.TABS. ASTELLAS PHAR... 377.00 EGP (12.57/unit) SOFENACIN 1MG/ML ORAL SUSP. 120 ML MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 88.00 EGP -> ? strength differs, ? different route - not oral solid URGINAFECT 1MG/ML ORAL SUSP. 150 ML FUTURE PHARMACEUTICAL INDUSTRIES (FP... 88.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Urge Incontinence - disease-level clinical article (overactive-bladder-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Antimuscarinic agents (solifenacin, oxybutynin, tolterodine) can worsen dementia/Alzheimer disease progression in older patients with cognitive impairment; third-line non-drug options should be considered earlier in this population. 3. OXYBUTYNIN [2nd line] Adult 2.5-5 mg two to three times daily (max 5 mg four times daily) - long-term Peds Over 5 years: 2.5 to 5 mg twice or three times daily. There is no mg/kg figure for this drug. (Dosed by age, not by weight. Over 5 years: 2.5-5 mg twice or three times daily for nocturnal enuresis or neurogenic bladder. There is no mg/kg figure for this drug.) Source Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) Why Oxybutynin is an older antimuscarinic that also relaxes the detrusor muscle to control urgency and frequency; it is kept as an alternative to solifenacin, though it crosses more readily into the central nervous system and carries a heavier anticholinergic burden. Caution Oxybutynin has a higher incidence of dry mouth and central anticholinergic effects compared to solifenacin. Reduce dose in elderly patients. In the elderly the half-life is longer: start 2.5 mg twice daily, more so if the patient is frail, and go no higher than 5 mg twice daily unless it is tolerated. Oxybutynin is strongly anticholinergic - confusion, dry mouth, constipation and falls. Egypt DRY TROPAN 5MG MR 10 CAPS. BORG 11.00 EGP (1.10/unit) DETRONIN 5 MG 20 TABS. PHAROPHARMA 26.00 EGP (1.30/unit) OXYBIN 5 MG 20 TAB. EIPICO 26.00 EGP (1.30/unit) URIPAN 5 MG 30 TABS. ADWIA 54.00 EGP (1.80/unit) OXURATE 1MG/ML SYRUP 120ML SIGMA 6.50 EGP -> ? strength differs, ? different route - not oral solid DRY TROPAN 2.5MG/5ML ELIXIR 120 ML BORG 7.00 EGP -> ? strength differs, ? different route - not oral solid 4. TOLTERODINE [2nd line] Adult Prolonged release: 4 mg once daily, swallowed whole, with or without food. Reduce to 2 mg once daily in hepatic impairment, in severe renal impairment (GFR 30 mL/min or less), or if side effects are intolerable - Reassess response and tolerability at 2-3 weeks; continue only if effective, and review at least every 6 months Peds Efficacy has not been demonstrated in children; not recommended. Childhood urinary incontinence is covered by the Nocturnal Enuresis condition. Choice Alternatives. Oxybutynin carries the heaviest anticholinergic burden of the three and is the one to avoid in an older patient; mirabegron is the most expensive. Tolterodine sits between them. Source eMC SmPC, Detrusitol XL 4 mg prolonged-release capsules (Viatris), sections 4.1 and 4.2 Why 14 live products. The SmPC indication is symptomatic treatment of urge incontinence and increased urinary frequency and urgency in overactive bladder syndrome, which is this condition verbatim. It gives a third antimuscarinic option at a different dose-reduction profile from the two already listed. Caution Use one antimuscarinic only - it replaces the oxybutynin or solifenacin already listed, it does not add to them. CONTRAINDICATED in urinary retention, uncontrolled narrow-angle glaucoma and gastric retention. Total anticholinergic burden matters, especially in an older patient already on an antihistamine, a tricyclic or an antiemetic - confusion and falls follow. Dry mouth affected 23.4% in trials; also constipation, dyspepsia and dry eyes. Halve the dose to 2 mg daily in hepatic impairment or GFR 30 mL/min or less. Detrusitol XL 4mg prolonged-release capsules, hard SmPC section 4.2 (eMC product 1535): "The recommended dose is 4 mg once daily except in patients with impaired liver function or severely impaired renal function (GFR ≤ 30 ml/min) for whom the recommended dose is 2 mg once daily." Avoid with potent CYP3A4 inhibitors, and use with caution where there are QT prolongation risk factors. Detrusitol XL 4mg prolonged-release capsules, hard SmPC sections 4.4 and 4.5 (eMC product 1535): "Concomitant treatment with potent CYP3A4 inhibitors should be avoided" and "Tolterodine should be used with caution in patients with risk factors for QT prolongation". In a frail older adult, mirabegron (already in this row) usually causes fewer cognitive problems - consider it first. Egypt TERODINE 1MG 10 SCORED TAB. PHAROPHARMA 9.50 EGP [? strength differs] BETA-3 AGONIST FOR PATIENTS WHO CANNOT TOLERATE AN ANTIMUSCARINIC 5. MIRABEGRON [2nd line] Adult 50 mg once daily. SmPC verbatim: "The recommended dose is 50 mg once daily." Kidney and liver change it - from the SmPC's own dosing table, severe renal impairment (eGFR 15 to 29) and moderate hepatic impairment (Child-Pugh Class B) take 25 mg, and end-stage renal disease or severe hepatic impairment are "Not recommended". A strong CYP3A inhibitor alongside caps the dose at 25 mg in mild to moderate renal or mild hepatic impairment. - long-term Peds Not established for overactive bladder in children. The label does carry a weight-based paediatric schedule, but for a different condition - neurogenic detrusor overactivity from 3 to under 18 years - so it does not transfer to this one. Source Mirabegron Astellas 50 mg prolonged-release tablets SmPC sections 4.1-4.2 (eMC product 7540) Why Mirabegron is a beta-3 adrenergic agonist that relaxes the detrusor muscle during bladder filling through a non-anticholinergic mechanism, making it an alternative for overactive bladder when antimuscarinics such as solifenacin or oxybutynin are contraindicated or poorly tolerated. Caution With a strong CYP3A inhibitor the label caps the dose at 25 mg in mild to moderate renal or mild hepatic impairment, and does not recommend the drug at all in severe renal or moderate hepatic impairment. Mirabegron is a beta-3 agonist alternative when anticholinergics are contraindicated or poorly tolerated. Contraindicated in severe uncontrolled hypertension (SBP >=180 or DBP >=110 mmHg). Monitor blood pressure regularly. Contraindicated in severe uncontrolled hypertension. SmPC verbatim: "Severe uncontrolled hypertension defined as systolic blood pressure 180 mm Hg and/or diastolic blood pressure 110 mm Hg." Take the blood pressure before the first tablet, not at the first review. It raises blood pressure by design of its mechanism. SmPC verbatim: "Mirabegron can increase blood pressure." and "Data are limited in patients with stage 2 hypertension (systolic blood pressure 160 mm Hg or diastolic blood pressure 100 mm Hg)." Not for advanced kidney or liver disease. SmPC verbatim: "Mirabegron Astellas has not been studied in patients with end stage renal disease (ESRD) (estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m 2 ), patients requiring haemodialysis, or patients with severe hepatic impairment (Child-Pugh Class C) and, therefore, it is not recommended for use in these patient populations." Caution where the QT interval is already long. SmPC verbatim: "since patients with a known history of QT prolongation or patients who are taking medicinal products known to prolong the QT interval were not included in these studies, the effects of mirabegron in these patients is unknown." Combining it with the antimuscarinic is a specialist decision, not an automatic next step. The disease article allows that in some cases an anticholinergic added to mirabegron can work better while keeping the side-effect burden down. A combined solifenacin and mirabegron product is on the Egyptian register, and it doubles the blood-pressure question. Egypt MIRABLAD XR 50 MG 10 F.C. TABS. RAMEDA 97.00 EGP (9.70/unit) BLADOGRA XR 50 MG 30 F.C. TABS. MULTI-APEX 357.00 EGP (11.90/unit) ATOBEGRON XR 50 MG 30 F.C. TABS. ATCO PHARMA 381.00 EGP (12.70/unit) URIBLADON XR 50 MG 30 F.C. TABS. GLOBAL ADVANC... 516.00 EGP (17.20/unit) FLOWADJUST 50 MG 30 PROLONGED REL. TABS. AMOUN 498.00 EGP BETMIGA 50 MG 30 PROLONGED R.TABS. ASTELLAS PHARMA > MULTIPHARMA 562.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)