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Increases In Blood Pressure
MYRBETRIQ® can increase blood pressure. Periodic blood pressure determinations are recommended, especially in hypertensive patients. MYRBETRIQ® is not recommended for use in patients with severe uncontrolled hypertension (defined as systolic blood pressure greater than or equal to 180 mm Hg and/or diastolic blood pressure greater than or equal to 110 mm Hg) [see CLINICAL PHARMACOLOGY].
In two, randomized, placebo-controlled, healthy volunteer studies, MYRBETRIQ® was associated with dose-related increases in supine blood pressure. In these studies, at the maximum recommended dose of 50 mg, the mean maximum increase in systolic/diastolic blood pressure was approximately 3.5/1.5 mm Hg greater than placebo.
In contrast, in OAB patients in clinical trials, the mean increase in systolic and diastolic blood pressure at the maximum recommended dose of 50 mg was approximately 0.5 - 1 mm Hg greater than placebo. Worsening of pre-existing hypertension was reported infrequently in MYRBETRIQ® patients.
Urinary Retention In Patients With Bladder Outlet Obstruction And In Patients Taking Antimuscarinic Medications For OAB
Urinary retention in patients with bladder outlet obstruction (BOO) and in patients taking antimuscarinic medications for the treatment of OAB has been reported in postmarketing experience in patients taking mirabegron. A controlled clinical safety study in patients with BOO did not demonstrate increased urinary retention in MYRBETRIQ® patients; however, MYRBETRIQ® should be administered with caution to patients with clinically significant BOO. MYRBETRIQ® should also be administered with caution to patients taking antimuscarinic medications for the treatment of OAB [see CLINICAL PHARMACOLOGY].
Angioedema of the face, lips, tongue, and/or larynx has been reported with MYRBETRIQ® . In some cases angioedema occurred after the first dose. Cases of angioedema have been reported to occur hours after the first dose or after multiple doses. Angioedema associated with upper airway swelling may be life threatening. If involvement of the tongue, hypopharynx, or larynx occurs, promptly discontinue MYRBETRIQ® and initiate appropriate therapy and/or measures necessary to ensure a patent airway [see ADVERSE REACTIONS].
Patients Taking Drugs Metabolized By CYP2D6
Since mirabegron is a moderate CYP2D6 inhibitor, the systemic exposure to CYP2D6 substrates such as metoprolol and desipramine is increased when co-administered with mirabegron. Therefore, appropriate monitoring and dose adjustment may be necessary, especially with narrow therapeutic index drugs metabolized by CYP2D6, such as thioridazine, flecainide, and propafenone [see DRUG INTERACTIONS and CLINICAL PHARMACOLOGY].
Patient Counseling Information
See FDA-approved patient labeling (PATIENT INFORMATION)
Inform patients that MYRBETRIQ® may increase blood pressure. Periodic blood pressure determinations are recommended, especially in patients with hypertension. MYRBETRIQ® has also been associated with infrequent urinary tract infections, rapid heartbeat, rash, and pruritus. Inform patients that urinary retention has been reported when taking mirabegron in combination with antimuscarinic drugs used in the treatment of overactive bladder. Instruct patients to contact their physician if they experience these effects while taking MYRBETRIQ® .
Patients should read the patient leaflet entitled “PATIENT INFORMATION” before starting therapy with MYRBETRIQ® .
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Long-term carcinogenicity studies were conducted in rats and mice dosed orally with mirabegron for two years. Male rats were dosed at 0, 12.5, 25, or 50 mg/kg/day and female rats and both sexes of mice were dosed at 0, 25, 50, or 100 mg/kg/day. Mirabegron showed no carcinogenic potential at systemic exposures (AUC) 38 to 45-fold higher in rats and 21 to 38-fold higher in mice than the human systemic exposure at the 50 mg dose.
Mirabegron was not mutagenic in the Ames bacterial reverse mutation assay, did not induce chromosomal aberrations in human peripheral blood lymphocytes at concentrations that were not cytotoxic, and was not clastogenic in the rat micronucleus assay.
Impairment Of Fertility
Fertility studies in rats showed that mirabegron had no effect on either male or female fertility at nonlethal doses up to 100 mg/kg/day. Systemic exposures (AUC) at 100 mg/kg in female rats was estimated to be 22 times the MRHD in women and 93 times the MRHD in men.
Use In Specific Populations
Pregnancy Category C
There are no adequate and well-controlled studies using MYRBETRIQ® in pregnant women. MYRBETRIQ® should be used during pregnancy only if the potential benefit to the patient outweighs the risk to the patient and fetus. Women who become pregnant during MYRBETRIQ® treatment are encouraged to contact their physician.
Based on animal data, mirabegron is predicted to have a low probability of increasing the risk of adverse developmental outcomes above background risk. Reversible adverse developmental findings consisting of delayed ossification and wavy ribs in rats and decreased fetal body weights in rabbits occurred at exposures greater than or equal to 22 and 14 times, respectively, the maximum recommended human dose (MRHD). At maternally toxic exposures decreased fetal weights were observed in rats and rabbits, and fetal death, dilated aorta, and cardiomegaly were reported in rabbits.
In the rat embryo/fetal developmental toxicity study, pregnant rats received daily oral doses of mirabegron at 0, 10, 30, 100, or 300 mg/kg from implantation to closure of the fetal hard palate (7th ¬to 17th ¬day of gestation). Maternal systemic exposures were approximately 0, 1, 6, 22, or 96 times greater than exposures in women treated at the MRHD of 50 mg based on AUC. No embryo/fetal toxicities were observed in rats exposed up to 6 times the human systemic exposure at the MRHD of 50 mg. At systemic exposures equal to or greater than 22 times the human systemic exposure at the MRHD, delayed ossification and wavy ribs were observed in fetuses at an increased incidence. These findings were reversible.
In the rabbit embryo/fetal developmental toxicity study, pregnant rabbits received daily oral doses of mirabegron at 0, 3, 10, or 30 mg/kg from implantation to closure of the fetal hard palate (6th ¬to 20th ¬day of gestation). Maternal systemic exposures were 0, 1, 14, or 36 times that in women treated at the MRHD of 50 mg based on AUC. The embryo/fetal No Adverse Effect Level (NOAEL) was similar to the exposure in women at the MRHD and was established in this species based on reduced fetal body weight observed at systemic exposures that were 14-fold higher than the human systemic exposure at MRHD. At higher doses, where systemic exposures were 36-fold higher than the human exposure at MRHD, maternal body weight gain and food consumption were reduced, one of 17 pregnant rabbits died, the incidence of fetal death increased, and fetal findings of dilated aorta and cardiomegaly were reported.
The effects of mirabegron on prenatal and postnatal development was assessed in pregnant rats dosed at 0, 10, 30, or 100 mg/kg/day from the seventh day of gestation until 20 days after birth. Maternal systemic exposures were 0, 1, 6, and 22 times the exposure in women at the MRHD based on AUC. Rat pups exposed to mirabegron in utero and through 21 days of lactation had no discernable adverse effects at maternal systemic exposures 6 times the MRHD. A slight but statistically significant decrease in the survival of pups was observed 4 days after birth at exposures 22 times the MRHD (92.7% survival) compared to the control group (98.8%), however, there was no effect on survival of pups 21 days after birth. Absolute body weight of pups was not affected on the day of birth. However, at the 30 mg/kg dose (22-fold higher systemic exposure than humans at MRHD) body weight gain of pups was reduced 5% to 13% from postnatal day 4 to 7 but not throughout the remainder of the lactation period. In utero and lactational exposure did not affect behavior or fertility of offspring at exposures up to 22 times the MRHD.
It is not known whether MYRBETRIQ® is excreted in human milk. Mirabegron was found in the milk of rats at concentrations twice the maternal plasma level. Mirabegron was found in the lungs, liver, and kidneys of nursing pups. No studies have been conducted to assess the impact of MYRBETRIQ® on milk production in humans, its presence in human breast milk, or its effects on the breast-fed child. Because MYRBETRIQ® is predicted to be excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
The safety and effectiveness of MYRBETRIQ® in pediatric patients have not been established.
No dose adjustment is necessary for the elderly. The pharmacokinetics of MYRBETRIQ® is not significantly influenced by age [see CLINICAL PHARMACOLOGY]. Of 5648 patients who received MYRBETRIQ® in the phase 2 and 3 studies, 2029 (35.9%) were 65 years of age or older, and 557 (9.9%) were 75 years of age or older. No overall differences in safety or effectiveness were observed between patients younger than 65 years of age and those 65 years of age or older in these studies.
MYRBETRIQ® has not been studied in patients with end stage renal disease (CLcr < 15 mL/min or eGFR < 15 mL/min/1.73 m or patients requiring hemodialysis), and, therefore is not recommended for use in these patient populations.
In patients with severe renal impairment (CLcr 15 to 29 mL/min or eGFR 15 to 29 mL/min/1.73 m²), the daily dose of MYRBETRIQ® should not exceed 25 mg. No dose adjustment is necessary in patients with mild or moderate renal impairment (CLcr 30 to 89 mL/min or eGFR 30 to 89 mL/min/1.73 m²) [see CLINICAL PHARMACOLOGY].
MYRBETRIQ® has not been studied in patients with severe hepatic impairment (Child-Pugh Class C), and therefore is not recommended for use in this patient population.
In patients with moderate hepatic impairment (Child-Pugh Class B), the daily dose of MYRBETRIQ® should not exceed 25 mg. No dose adjustment is necessary in patients with mild hepatic impairment (Child-Pugh Class A) [see CLINICAL PHARMACOLOGY].
No dose adjustment is necessary based on gender. When corrected for differences in body weight, the MYRBETRIQ® systemic exposure is 20% to 30% higher in females compared to males.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 8/29/2016
Additional Myrbetriq Information
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