Medical Director, Milne Institute Gaylord Hospital Wallingford, Connecticut, United States
Research Objectives: To describe the use of mirabegron, a beta-3 adrenergic receptor agonist, in combination with dicyclomine, a muscarinic antagonist with noncompetitive inhibition of histamine and bradykinin, to control incontinence between catheterizations in neurogenic detrusor overactivity (NDO) following traumatic spinal cord injury.
Design: Case report
Setting: Inpatient acute rehab in a long-term acute care hospital
Participants: 42 yo male status post motor vehicle accident with L1 ASIA A paraplegia
Interventions: Inpatient rehabilitation was complicated by neurogenic detrusor overactivity (NDO), with incontinence between catheterizations. He did not tolerate first line treatment with oxybutynin and then solifenacin, due to anticholinergic side effects, including constipation. Mirabegron was tolerated, but not completely effective in eliminating episodes of incontinence between catheterizations. After the addition and titration of dicyclomine to 20 mg four times daily, patient had interval improvement in urinary incontinence. There was good tolerance with no adverse effects.
Main Outcome Measures: Urinary incontinence between catheterization
Results: Dicyclomine, when used in addition to mirabegron, was well tolerated and demonstrated interval improvement in urinary incontinence between catheterization in a patient with NDO secondary to traumatic spinal cord injury.
Conclusions: Neurogenic bladder following spinal cord injury is common and can cause medical and social complications. Medications typically used first line to treat NDO may have intolerable adverse effects. Mirabegron can be effective, but not always when used as a single agent. The addition of dicyclomine may be an effective alternative for NDO due to its activity on muscarinic receptors, and its unique additional inhibition of histamine and bradykinin. Dicyclomine, in combination with mirabegron, can be effective and well tolerated in patients with NDO after traumatic spinal cord injury. Neurogenic detrusor overactivity, as well as the pharmacology, dosing, and use of both mirabegron and dicyclomine will be reviewed.
Author(s) Disclosures: No disclosures
Learning Objectives:
Upon completion, participant will be able to gain an understanding of neurogenic detrusor overactivity following traumatic spinal cord injury.
Upon completion, participant will be able to gain an understanding in the importance of treatment of neurogenic bladder following spinal cord injury.
Upon completion, participant will be able to gain an understanding for treatment options, including pharmacology and dosing of dicyclomine and mirabegron.
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