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Beta-3 Adrenoceptor Agonist Pregnancy: C

Mirabegron

Brand names: Betmiga

Adult dose

Dose: 50 mg once daily; 25 mg once daily in severe renal/hepatic impairment
Route: oral
Frequency: once daily
Max: 50 mg/day
Not antimuscarinic — alternative for patients intolerant of antimuscarinics; swallow whole with water; moderate CYP2D6 inhibitor — check interactions

Paediatric dose

Route:
Not licensed in children under 18 years

Dose adjustments

Renal

25 mg/day if eGFR <30 ml/min; avoid if eGFR <15 ml/min

Hepatic

25 mg/day in severe hepatic impairment (Child-Pugh C); avoid if very severe

Clinical pearls

  • No antimuscarinic side effects — preferred in elderly, cognitive impairment, or dry mouth-intolerant patients
  • Licensed combination with solifenacin (Vesicare Combo) for refractory OAB
  • Moderate CYP2D6 inhibitor — check for interactions before prescribing

Contraindications

  • Severe uncontrolled hypertension (SBP ≥180 mmHg)
  • ESRD
  • Severe hepatic impairment

Side effects

  • Hypertension
  • Tachycardia
  • UTI
  • Nasopharyngitis
  • Headache
  • Nausea

Interactions

  • Digoxin (monitor levels — CYP2D6 inhibition)
  • Flecainide/propafenone (increased levels)
  • Warfarin (increased exposure)
  • Solifenacin (combination licensed — Vesicare Combo)

Monitoring

  • Blood pressure
  • Heart rate
  • OAB symptom scores

Reference: BNFc; BNF 86; NICE NG123; SCORPIO trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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