Selective β3-adrenoceptor agonist for overactive bladder
ATC code: G04BD12 (Mirabegron)
Brand names
Betmiga, Myrbetriq, Vesomni
A selective β3-adrenoceptor agonist on bladder detrusor. β3 stimulation during filling phase relaxes the detrusor, increases bladder capacity, and reduces involuntary contractions. Unlike antimuscarinics, no anticholinergic side effects (no dry mouth, constipation, or cognitive impairment), but BP and HR may rise – monitoring is needed. CYP3A4- and CYP2D6-metabolized.
Second line
Second-line for overactive bladder alongside antimuscarinics per EAU 2024 and AUA 2019. Dose 50 mg once daily; start at 25 mg in older adults or with moderate renal/hepatic impairment. Efficacy is comparable to solifenacin and (SCORPIO trial), without anticholinergic side effects – preferred in older patients and those intolerant of dry mouth. Combination mirabegron + solifenacin (combined formulation Vesomni) can be used when monotherapy is insufficient.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Mirabegron is a selective β3-adrenergic agonist. It is prescribed for overactive bladder (AEMPS Ficha Técnica). Mirabegron is positioned as a modern β3-agonist for anti-aging of the urinary system. No clinical studies of prophylactic use outside overactive bladder exist. The drug can cause hypertension (requires monitoring before and during treatment), urinary retention, tachycardia, headache, and urinary tract infections. If mirabegron was prescribed outside confirmed overactive bladder, consider seeking a second opinion.
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Limited pregnancy data. OAB in pregnancy usually does not require pharmacotherapy – behavioral measures are first-line. When treatment is needed, defer to postpartum.
No data on milk excretion. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Mirabegron is evaluated for the following indications with varying evidence strength: Overactive bladder (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Mirabegron (≥ 1 in 100): Tachycardia, Increased BP, Urinary tract infections, Headache, Nasopharyngitis, Constipation. See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. OAB in pregnancy usually does not require pharmacotherapy – behavioral measures are first-line. When treatment is needed, defer to postpartum.
No data on milk excretion. Not used during lactation.
Mirabegron is contraindicated in: Mirabegron hypersensitivity; Severe uncontrolled hypertension (BP over 180/110); Severe hepatic impairment; Severe renal impairment (eGFR under 15). Full list in the Safety section.