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Urge incontinence treatment options

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  • Urge incontinence treatment options

    Several potential medications have been presented to me as options to treat urge incontinence. I am breastfeeding my 12 month old, and hope to continue to do so. The meds suggested include ditropan (oxybutynin), vesicare (solifenacin succinate), toviaz (fesoterodine), or myrbetriq (mirabegron). I'm trying to decide whether I should try one of these medications. I am concerned about safety in terms of breastmilk, and also the potential side effect of reducing milk supply (it seems like several of them indicate a side effect of dry mouth/dry eye).

  • #2

    Ditropan (oxybutynin) is rated an L3-no data-probably compatible. Milk levels are not published, but are probably low. It is poorly absorbed orally only 6% is orally bioavailable. We think this medication is probably ok to nurse on as long as your infant is not symptomatic. With any medication we recommend taking it right after nursing so you have a break before nursing again. Monitor your infant for nausea, dry mouth, constipation, urinary hesitancy, flushing and urticaria.

    Vesicare (solifenacin) is rated an L4-no data-possibly hazardous. "Solifenacin is an unusual anticholinergic, structurally different but similar in effect to atropine. We do not have data on its use in breastfeeding mothers. However, the potency of this product, its effect on numerous important organs, the sensitivity of infants to anticholinergic agents, and its long-half life make this product problematic for breastfeeding infants. It is likely that milk levels will ultimately be low (due to its structure), no data are available at present, and caution is recommended. This product should be used with significant caution in breastfeeding mothers, if at all. Should the clinician decide that the need is great, and the mother insists on breastfeeding, then observe the infant for urinary retention, dry mouth, constipation, UTI, and other antimuscarinic symptoms. In reality, I think these symptoms are probably unlikely." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    Toviaz (fesoterodine) is rated an L3- no data-probably compatible. We do not know how much transfers into breast milk, however it is unlikely concentrations will be high enough to produce untoward effects in your infant. Monitor your infant for insomnia, dry mouth, constipation, urinary retention, weight gain.

    Myrbetriq (mirabegron) is rated an L3-no data-probably compatible. We do not know how much transfers into breast milk. The oral bioavailability is 29-35% but this is dose dependent. This medication is probably compatible with breastfeeding, but oxybutynin may be a better alternative since it has lower oral bioavailability. Monitor your infant for vomiting, constipation or diarrhea, urinary retention.

    Sandra Lovato R.N.
    InfantRisk Center