Betmiga/Mirabegron 5omgs?
My Dad has seen a urologist who has prescribed Betmiga/Mirabegron 50mgs - its meant to relax the bladder muscles and stop him having the urge to going to the loo as frequently.
It seems to have the reverse effect - has anyone experienced this?
On the medication he has the urge to go to the loo every 5-10 minutes but very little happens.
All help would be really appreciated - we’re all at our wits end - do we stop the medication?
I'm not a urologist but I have some suggestions to consider:
1. Read the FDA label on the drug. Your Dad may have a copy with the packaging he received for the drug, but probably not. It can be found by going to the FDA website and looking up "mirabegron". I found it here:
accessdata.fda.gov/drugsatf...
Check the FDA info for side effects, drug interactions, things that one shouldn't do with the drug, etc.
2. Ask your Dad to stop taking the drug and see if the condition improves. If so, then this isn't a good drug for him. The drug was not prescribed to cure a disease but rather to make him more comfortable. Since it's not having that effect I can't think of any good reason to continue taking it. This should be confirmed with the urologist just in case there is some proper procedure for getting off the drug, e.g., cutting it back over a period of time rather than all at once.
3. Have your Dad ask the urologist for a urinalysis. I had a kidney stone that either caused or was associated with a urinary tract infection (UTI). I had tremendous urges to urinate, every 10 or 15 minutes, but there was no urine to come out. I couldn't sleep and was in considerable pain. The problem was resolved by taking tamulosin, which helped me to pass the kidney stone, and an antibiotic that cured the infection.A urinalysis can detect a UTI. If the urologist thinks that a kidney stone is a possibility, then a CT scan or MRI might see it.
4. Consider a different drug. Tamulosin (trade name Flomax) is often prescribed for this problem. But the first thing is to fix the pain and super urgency and get back to baseline before trying any new drugs.
As I say, I'm not a doctor. My opinion is strictly non-professional.
Best of luck.
Alan
Dear Alan - thanks for the advice - it’s awful to be old. My Dad has gone from being a strong man to a man who can hardly walk, needs help every time he goes to the loo etc. I hope god takes him soon. Thank you for taking the time and trouble to offer advice.
Regards
Maria
Here in the U.S. there are some good palliative care facilities (and some bad ones too, unfortunately.) Their goal is not treatment but comfort. I don't know if your Dad has access to that sort of place or not, but it might be worth investigating if he isn't already in such a facility.
I understand your wishes for him. Sometimes people think that thoughts like that are harsh, but when a person is suffering worse and worse and worse with no hope of getting better and nothing but more and worse pain and suffering in his future, a quick end can be the most merciful outcome.
I wish the best to you and your Dad.
Alan
Dear Alan - thank you for your kind words. You seem very knowledgeable -I’d be interested in your advice. DaD is 91 years old living with my Mum 88years old. I love 250 miles away from them. I normally stay with them 1 week in four.
dad has various health problems - enlarged prostate, pulmonary fibrosis, PMR, peripheral neuropathy, early/moderate dementia. On a daily basis he is in no pain. He eats well - but the big problem is his bladder. Last night I got up with him 11 times in a 12 hour period.( He won’t use a urine bottle or commode and he’s unsteady on his feet)
He’s tried 2 different drugs for reducing the urge but neither have helped - they seem to have had the opposite effect.
The doctors are pushing for a catheter but everything i’ve Read says it doesn’t always stop the urge - plus they come with a heap of other problems. For example Dad might still get the urge and try and pull the catheter out. We live in England - do you have any suggestions or are there any new treatments we can try?
I would be really grateful for your input.
Regards
Maria
Dear Maria,
My own experience with my Mom and my mother-in-law, both of whom died with advanced Alzheimer's Disease, is that dementia makes an already difficult situation ten times more difficult.
At this point I think it is important that you and your mother take care of your own needs. You are doing heroic work by leaving your own home and family for one week a month, but you and your Mom are wearing yourselves out without being able to improve your Dad's condition. The best you can achieve is to keep your Dad alive and reduce some of his difficulties to some degree, and that degree will be lower and lower over time.
I don't know your family or the situation in the UK, but I suggest that, if possible, you think about find the best institutional care that you can find for your Dad. It won't be like living at home. He may feel disoriented. He may feel abandoned. Whatever familiar routines he has will have to change. He may regard the other residents in a hostile manner and be put off by their behavior, as they may be by him. But, if it is a decent place, his physical needs will be attended to and he will be safe. Your Mom will be able to visit him as often as practical for her and, if she is able by herself, or the two of you together when you visit, you can take him out for lunches or for outings. When it's not practical to visit, you may be able to speak to him on the phone. Your time with him may be more family get together and less battling with his urinary and sleep problems.
I make this suggestion not because of your Dad's prostate cancer, but because of his problems with dementia. The fact that he won't pee into a bottle or a commode indicates that the cognitive issues are causing more problems than the physical ones. After a radiation treatment I found myself having to get up every hour at night to urinate. I kept a jar with a tight fitting lid by the bed. I lived this way for some months. It was inconvenient but I was able to live with it and not let it drive me (or my wife) nuts. It was just something that had to be endured.
If your Dad is able to communicate reasonably well and is not too cranky and difficult, you may be able to place him in a facility where many or even most of the residents do not have dementia, or have only mild cognitive problems. He may be able to form friendships. If he likes to play card games or watch sports on TV or do other things with people, he may actually be happier there than at home. Even in an Alzheimer's residence where everyone has at least some cognitive problems, that might be the case. Good residences will organize such activities and will have music and church services for those who like them, movies, and organized games and physical activities.
Care will probably not be as patient and individualized as you and your Mom provide. They'll probably put diapers on him. He may not have a private room. But, hopefully, the people will be respectful and caring. You can help insure that by choosing a good place, and by visiting often enough and asking questions, both of your Dad and of the staff, to demonstrate that your Dad's family is involved, helpful, understanding of the difficulties but committed to his receiving good quality care.
Of course I don't know if that's the right thing for your family or not. However if you and your Mom agree that it is the right thing to do, I think you should be prepared to overcome any resistance that he makes. Neither you nor he will be able to make a fair judgment until he's at least tried it.
If this makes sense to you, or if you want to get more information in order to determine if it makes sense, get a list of the local facilities. There may be a social services agency that has such a list and may even have ratings. Call them. Arrange visits - just you or other family members at first, not your Dad. There's no point in getting him riled up by some place where you wouldn't want him to go anyway. Get prices and find out how much the NHS or other social services will pay. Meet as many of the staff as you can and talk to the residents. Look at how they appear. Are they clean and neat? Do they seem friendly and reasonably happy, or drugged, depressed, or withdrawn into themselves? See if there's a family support group where you can meet family members of other residents, ask questions, and get their perspectives. Ask if the residence has a social worker who can visit your home and make an evaluation of your father. I see that there is a "Memory Health: Alzheimer's Support Group" here on HealthUnlocked and there are no doubt many others on the Internet that can give you more information about these ideas. I suggest joining one of those.
You may decide that your Dad is not ready for this, but it might still be useful to you to gather information that will help you if you and your Mom later change your minds.
Please take my suggestions as just the thoughts of an outsider who really doesn't know your Dad or your situation. They may be completely wrong for your family. You'll know far better than I will what should be done, but I hope I've been of some help.
Best of luck.
Alan
Dear Alan - I am grateful beyond belief that you took the tinme and trouble to respond to my email. ( the kindness of strangers)
My Dad is the kindest , sweetest most wonderful man ever - he never complains. this evening i asked him how he was and he said ‘i’m not as i am’ rthis is the first time he ‘s realised that he’s not himself/. It broke my heart. In my heart of hearts I know where this is heading but Idon’t want to let him down. Life can be so cruel - I REALLY APPRECIATE YOUR CARE AND ADVICE
Regards
Maria Welland
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