A 48-year-old woman has urgency, daytime frequency of more than eight micturitions, nocturia, and urge incontinence. Examination and urodynamics show detrusor overactivity with no evidence of stress incontinence. After lifestyle advice and bladder training fail, the first-line drug therapy is:
- A Mirabegron
- B Topical vaginal estrogen
- C An antimuscarinic agent such as solifenacin ✓
- D Imipramine
Correct answer: C. An antimuscarinic agent such as solifenacin
Explanation
Antimuscarinics block M3 receptors on the detrusor, reducing involuntary contractions, and remain the first-line pharmacotherapy for overactive bladder after conservative measures fail, as recommended by NICE. Mirabegron, a beta-3 adrenergic agonist, is second line, used when antimuscarinics are ineffective or not tolerated, for example in women troubled by dryness or cognitive side effects. Topical estrogen alone does not treat detrusor overactivity.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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