Spina Bifida Medication

Updated: Sep 22, 2016
  • Author: Mark R Foster, MD, PhD, FACS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Medication

Medication Summary

The medications used most frequently in myelomeningocele are for treatment of neurogenic bladder dysfunction. These medications are used in conjunction with some form of bladder emptying technique to prevent upper urinary tract complications and to facilitate social continence. Among the drugs used are the following:

  • Anticholinergics (oxybutynin chloride, hyoscyamine sulfate)

  • Tricyclic antidepressants (imipramine hydrochloride; may act through anticholinergic effects)

  • Alpha-adrenergic antagonists (terazosin)

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Antispasmodic Agents, Urinary

Class Summary

These drugs competitively inhibit the binding of acetylcholine to the muscarinic cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. In addition, they increase the volume at the first involuntary bladder contraction, decrease the amplitude of the involuntary bladder contraction, and, possibly, increase bladder capacity.

Oxybutynin chloride (Ditropan, XL, Gelnique, Oxytrol)

Oxybutynin chloride (Ditropan, XL, Gelnique, Oxytrol)

Oxybutynin exerts a direct antispasmodic effect on smooth muscle and inhibits muscarinic action of acetylcholine on smooth muscle. It is used to decrease bladder contractility and reduce detrusor-sphincter dyssynergia. Intravesical instillation of oxybutynin is associated with fewer side effects. A long-acting oral form is also available, for once-daily dosing.

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Anticholinergics

Class Summary

Anticholinergics are used to suppress detrusor overactivity.

Hyoscyamine sulfate (Levsin, Levbid, Symax, Anaspaz, HyoMax)

Through parasympatholytic action, hyoscyamine relaxes smooth muscle spasms. It is indicated in the management of lower urinary tract disorders associated with hypermotility.

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Tricyclic Antidepressants

Class Summary

Tricyclic antidepressants may act through anticholinergic effects.

Imipramine hydrochloride (Tofranil)

Imipramine has significant anticholinergic activity, as well as some alpha-adrenergic activity. These combined effects may improve bladder-urethral storage function.

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Alpha-Adrenergic Antagonists

Class Summary

Alpha-adrenergic receptors are found in the bladder neck and urethra. Alpha-adrenergic antagonists decrease bladder outlet resistance, increase urinary flow rate, and improve bladder emptying.

Terazosin

Terazosin is an alpha 1-adrenergic blocking agent that decreases smooth muscle tone in the bladder neck, leading to reduction of bladder outlet obstruction without affecting bladder contractility. Its major side effects are postural hypotension and syncope, which can be avoided by starting at the lowest dose and increasing slowly. If terazosin therapy is discontinued for several days, restart using the initial dosing regimen.

Doxazosin mesylate (Cardura, Cardura XL)

Doxazosin is a selective inhibitor of alpha1-adrenergic receptors. Blockade of these receptors in the bladder neck decreases outflow resistance.

Alfuzosin (Uroxatral)

Doxazosin is a selective inhibitor of alpha1-adrenergic receptors. Blockade of adrenoreceptors relaxes smooth muscle in the in the bladder neck, which, in turn, decreases outflow resistance.

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