What are the recommended first-line pharmacological treatments for patients diagnosed with overactive bladder (OAB)?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

First-line pharmacological treatments for patients diagnosed with overactive bladder (OAB) are antimuscarinic (anticholinergic) medicines. The choice should be the anticholinergic medicine with the lowest acquisition cost.

If the first antimuscarinic medicine is not effective or well tolerated, another medicine with a low acquisition cost should be offered.

For women unable to tolerate oral medicines, a transdermal overactive bladder treatment is recommended.

Beta-3 adrenoceptor agonists such as mirabegron or vibegron are recommended as options if antimuscarinics are not suitable, not effective enough, or have unacceptable side effects.

Educational content only. Always verify information and use clinical judgement.