Issues for surgery
Risk of increased urinary frequency, urgency and urge incontinence if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Post-operative advice
Monitor renal function – dose reduction may be necessary if renal function is impaired (consult current product literature).
Patients undergoing overactive bladder surgery
Review the need for mirabegron post-operatively.
Interactions with common anaesthetic agents
QT-interval prolongation
See also Interactions with other common medicines used in the perioperative period.
Mirabegron has not demonstrated clinically relevant QT-interval prolongation in clinical studies. However, since patient who are taking medicinal products known to prolong the QT-interval were not included in these studies, the manufacturer advises caution when administering mirabegron concurrently with drugs that prolong the QT-interval (e.g. desflurane, isoflurane, sevoflurane and possibly thiopental).
Interactions with other common medicines used in the perioperative period
Tramadol
Mirabegron is predicted to increase the exposure to tramadol, but to reduce the exposure to its active metabolite; tramadol adverse effects are therefore increased but not its analgesic effect. The clinical importance of this interaction is unknown. If both drugs are given, be aware of reduced tramadol efficacy and monitor patients for serotonin syndrome (such as fever, tremors, diarrhoea, agitation); concurrent use should be stopped if serotonin syndrome occurs.
Clarithromycin
Clarithromycin is predicted to increase the exposure to mirabegron – limit the mirabegron dose to 25mg daily with mild to moderate renal impairment or mild hepatic impairment. Concurrent use is not recommended in severe renal impairment or moderate hepatic impairment.
QT-interval prolongation
Mirabegron has not demonstrated clinically relevant QT-interval prolongation in clinical studies. However, since patient who are taking medicinal products known to prolong the QT-interval were not included in these studies, the manufacturer advises caution when administering mirabegron concurrently with drugs that prolong the QT-interval (e.g. domperidone, clarithromycin, ondansetron).
Further information
None relevant.
References
Summary of Product Characteristics – Betmiga® (mirabegron) 50mg prolonged-release tablets. Zentiva. Accessed via www.medicines.org.uk 28/06/2019 [date of revision of the text April 2019]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 7th November 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 28th June 2019]