Berotralstat
Severe
Database
Drug interaction classified as: absorption
Source: DDInter
Drug reference
Mirabegron
Beta-3 adrenoceptor agonist · Overactive bladder (OAB) treatment
Also known as Betmiga, Myrbetriq
START
25 mg PO once daily, increase to 50 mg if needed/tolerated
TYPICAL MAX
50 mg/day (25 mg if moderate renal/hepatic impairment)
STOP IF
Severe/uncontrolled hypertension, urinary retention, angioedema
WATCH
BP (baseline + periodic), urinary retention especially with antimuscarinics, CYP2D6 substrates
CDSCO approvedSchedule HATC G04BD12
KDIGO 2024 + manufacturer label
- ONSET
- 3.5h · absorption
- PEAK
- 3.5h · Cmax
- t½
- 2.1d · plasma t½
- DURATION
- 1d · once-daily
EXCRETION
Hepatic metabolism; ~55% renal, rest faecal
route + CYP
INTERACTIONS
8 major
SEVERE in our sources
PREGNANCY
Avoid — limited data; OAB is non-life-threatening
FDA category + note
Top interactionssee all 12 →
- BerotralstatSevereDatabaseDDInter
- BrexpiprazoleSevereDatabaseDDInter
- EliglustatSevereDatabaseDDInter
- OliceridineSevereDatabaseDDInter
Available in India
42 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Selective beta-3 adrenoceptor agonist relaxing detrusor smooth muscle during bladder filling, increasing bladder capacity without significant antimuscarinic effects.
Indications
Overactive bladder (urgency, frequency, urge incontinence)Neurogenic detrusor overactivity (paediatric, regimen-dependent)
Dosing
- Adult
- 25 mg PO once daily; may increase to 50 mg once daily based on response/tolerability.
- Pediatric
- ≥3 years neurogenic detrusor overactivity: weight-based per label.
- Renal adjustment
- eGFR 15–29 or moderate hepatic impairment: max 25 mg/day. eGFR <15 / severe hepatic: not recommended.
- Hepatic adjustment
- Moderate (Child-Pugh B): max 25 mg/day. Severe: not recommended.
- Geriatric
- No specific adjustment; monitor BP.
- Max dose
- 50 mg/day (25 mg/day if moderate renal/hepatic impairment)
Pharmacokinetics
Onset
Steady state ~7 days; symptom benefit over weeks
Peak effect
Cmax ~3.5 h
Duration
Once daily
Half-life
~50 h
Bioavailability
~29–35% (dose-dependent)
Protein binding
~71%
Metabolism
Hepatic (CYP3A4, CYP2D6, others); moderate CYP2D6 inhibitor
Excretion
Renal (~55%) and faecal
Contraindications
- Severe uncontrolled hypertension (≥180/110 mmHg)
- Hypersensitivity to mirabegron
- End-stage renal disease/severe hepatic impairment (avoid)
Side effects
Common
HypertensionNasopharyngitis/UTIHeadacheTachycardiaConstipation
Serious
- Severe hypertension
- Urinary retention (esp. with bladder outlet obstruction + antimuscarinics)
- Angioedema
- Atrial fibrillation (rare)
Pregnancy & lactation
Pregnancy
Avoid — limited data; OAB is non-life-threatening
Lactation
Avoid (excreted in animal milk)
Drug interactions
Brexpiprazole
Severe
Database
Increased AUC by 2-fold.
Reduce brexpiprazole dose by 50%.
Source: DDInter
Eliglustat
Severe
Database
Clinical effect not specified
Source: DDInter
Oliceridine
Severe
Database
Clinical effect not specified
Source: DDInter
Pimozide
Severe
Database
Clinical effect not specified
Source: DDInter
Tamoxifen
Severe
Database
Clinical effect not specified
Source: DDInter
Thioridazine
Severe
Database
Clinical effect not specified
Source: DDInter
Venetoclax
Severe
Database
Clinical effect not specified
Source: DDInter
Acebutolol
Moderate
Textbook
Increased antihypertensive effect.
This combination is often used to achieve better blood pressure control and manage reflex tachycardia from alpha-1 blockers.
Source: G&G 14e
Atenolol
Moderate
Textbook
Increased antihypertensive effect.
This combination is often used to achieve better blood pressure control and manage reflex tachycardia from alpha-1 blockers.
Source: G&G 14e
Betaxolol
Moderate
Textbook
Increased antihypertensive effect.
This combination is often used to achieve better blood pressure control and manage reflex tachycardia from alpha-1 blockers.
Source: G&G 14e
Bisoprolol
Moderate
Textbook
Increased antihypertensive effect.
This combination is often used to achieve better blood pressure control and manage reflex tachycardia from alpha-1 blockers.
Source: G&G 14e
Related guidelines
Ask House about Mirabegron
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19