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Key Points
Previous evidence suggests concomitant use of drugs that are cytochrome P450 (CYP) 2D6 substrates with drugs that are CYP2D6 inhibitors may lead to increased concentration of the substrate and risk of drug‒drug interactions. |
Among patients receiving mirabegron, a moderate CYP2D6 inhibitor, codispensing with CYP2D6 substrates was common (~ 70%) among all adults and among patients ≥ 65 years old. |
Mirabegron users receiving one or more concurrent CYP2D6 substrate were more likely to be older, have more comorbidities and baseline polypharmacy, and have increased healthcare resource utilization compared with those without concurrent CYP2D6 substrate dispensings. |
Introduction
Overactive bladder (OAB) is a clinical diagnosis characterized by the presence of bothersome urinary symptoms including urgency, frequency, nocturia, and urge urinary incontinence [1]. Nearly one in four Americans aged ≥ 40 years has bothersome symptoms of OAB [2], and the proportion of adults with OAB increases with age in both men and women [2, 3]. In a large survey of adults in the United States, the percentage of respondents reporting frequency of OAB symptoms as at least “sometimes” rose from 17% for those 40‒45 years old to 49% for those ≥ 76 years old in male respondents and from 37 to 51%, respectively, in females [2]. Pharmacologic agents, including oral anticholinergics or β3-adrenergic receptor agonists, are recommended for the treatment of OAB [1]. While anticholinergics are commonly used treatments for OAB, it is generally recommended to avoid anticholinergics in older adults because increased use leads to greater anticholinergic burden (i.e., cumulative effects of taking one or more drug with anticholinergic properties) [1, 4] and associated risks [5, 6], including increased risk of dementia [6], as well as cardiovascular and neurologic side effects [5, 7].
Compared with adults without OAB, adults with OAB often have more comorbid medical conditions, such as hypertension, depression, and dementia [8, 9–10]. Likewise, older adults with OAB have higher rates of comorbidities, such as hypertension, psychiatric disorders, and urinary tract infections, than older adults without OAB [8]. Treatment of these comorbidities often necessitates pharmacologic management, leading to greater rates of polypharmacy. In a geriatric outpatient cohort study of 807 patients (mean age 81.7 years), in which 25.5% of patients had a history of or were currently experienced urinary incontinence, 84% were...