Vesicare: When is it Better than Generic Oxybutynin?

Vesicare is one of the older of the second generation medications for urge incontinence. Vesicare has been around long enough that its earliest patent expiration is anticipated in Dec. 2015. You may not hear much about urge incontinence now, because the more popular term for this is overactive bladder. Overactive bladder is a medical condition propagated by the drug companies to create a much larger market for their drugs to treat this condition. If only patients with incontinence are considered the market is much smaller than if patients with an urgency to void or more frequent voiding but no incontinence are also included. Now that we have new branded drugs like Vesicare and Toviaz a bigger market for these durgs is very valuable to pharma. On a less cynical note we have long treated patients with urgency or frequency but not incontinence with the medications for urge incontinence.

Vesicare is usually started at a 5 mg once daily dosage, and if needed increased to 10 mg daily. Vesicare is an not an extended release formulation despite its once daily dosing recommendation because of its very long serum half-life, so as a cost saving measure it should be possible to take a half-pill of the 10 mg dose. This is different from Toviaz, the other branded competitor which is an extended release product and should not be broken.
The generic drugs available for treatment of overactive bladder include ditropan (generic name oxybutynin) and detrol (generic name tolterodine expected to be available late in 2012). Oxybutyin is an inexpensive medication with similar mechanism of action as Vesicare and is effective for some women. The primary drawback of the older medications is a somewhat higher incidence of anticholinergic side effects. The more common of these side effects are dry mouth, constipation, dizziness, and drowsiness. The primary selling point for Vesicare and Toviaz is a somewhat lower incidence of these side effects leading to a somewhat higher level of patient tolerability.

Probably not coincidently the cost or Vesicare and Toviaz is nearly identical. Online published prices at is 170. for both drugs at both doses. In comparison the immediate release generic forms of the older drugs are much less expensive. Pricing for generic immediate release oxybutynin at Costco is 7.18/ 100 5 mg tablets.

Addendum: On April 5, 2012 the FDA advisory committee recommended approval of a new type of medication for overactive bladder, also by Astellas Pharma, the makers of Veiscare, which works by a different mechanism. The new drug called mirabegron 50 mg is a beta 3 adrenoceptor agonist, a completely new class of medication, and although there are potential concerns about elevation of blood pressure it may come to market soon. Having a truly different drug to treat this difficult problem is potentially a lot more exciting than drugs like Vesicare and Toviaz which are at best modest improvements over the older drugs available. Stay tuned for more on mirabigron if it gets FDA approval.

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