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Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations,  while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and...
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Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...
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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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Overactive bladder medication: Anticholinergics versus mirabegron by specialty.

Abhishek A Sripad1, Christina A Raker2, Vivian W Sung1

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Urologia
|February 23, 2022
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Summary

Primary care providers prescribed the most overactive bladder (OAB) medications for Medicare beneficiaries. Urologists showed the highest likelihood of prescribing mirabegron, a key OAB drug.

Keywords:
Anticholinergicsmirabegronoveractive bladder syndromeprescription patternprovider specialty

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Area of Science:

  • Pharmacology
  • Geriatric Medicine
  • Health Services Research

Background:

  • Overactive bladder (OAB) affects a significant portion of the elderly population.
  • Medication management for OAB is crucial for improving patient quality of life.
  • Understanding prescribing patterns is essential for optimizing OAB treatment strategies.

Purpose of the Study:

  • To identify the top specialties prescribing overactive bladder (OAB) medications among Medicare Part D beneficiaries.
  • To analyze OAB medication prescribing trends by specialty from 2013 to 2017.
  • To compare the distribution of OAB medication classes within each specialty.

Main Methods:

  • Utilized Medicare Part D Provider Public Use File data from 2013-2017.
  • Identified the four highest prescribing specialties for OAB medications.
  • Compared OAB medication prescription patterns, including claims, cost, and region, for beneficiaries aged 65 and older.
  • Classified OAB medications into anticholinergic and mirabegron categories.

Main Results:

  • Total OAB medication claims increased from 4.06 million in 2013 to 4.51 million in 2017.
  • Primary care providers (PCPs) prescribed the highest volume of OAB medications.
  • Mirabegron claims saw a substantial rise, from 65,520 to 892,996 during the study period.
  • Urologists exhibited the highest proportion of mirabegron prescribing (19.6%) and were more likely to prescribe it compared to OB/GYNs.

Conclusions:

  • Primary care providers were the leading prescribers of overactive bladder medications for Medicare beneficiaries between 2013 and 2017.
  • Urologists demonstrated the highest propensity for prescribing mirabegron, indicating a potential shift in OAB treatment preferences within this specialty.