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System Formulary Update
Mirabegron (Myrbetriq)
Situation
Mirabegron (Myrbetriq) was reviewed by the System P&T Committee. The active therapeutic interchange for Beta-3 Agonists, which currently converts mirabegron and vibegron to solifenacin at admission, was also reviewed.
Background
Mirabegron and vibegron were reviewed. Mirabegron is a common medication on prior to admission medication lists. Vibegron is infrequently on a prior to admission medication list. Both agents are beta-3 agonists and safer alternatives to antimuscarinics (e.g., solifenacin) in older patients or in patients with underlying dementia/cognitive dysfunction.
The following automatic therapeutic interchanges were reviewed and found to be inappropriate due to resulting antimuscarinic exposure in high-risk populations:
- Mirabegron 25 mg = solifenacin 5 mg
- Mirabegron 50 mg = solifenacin 10 mg
- Vibegron 75 mg = solifenacin 5 mg
Assessment/Recommendations
System P&T voted to include the following products on the UNC Health System Medication Formulary WITH RESTRICTION to continuation of home therapy:
- Mirabegron 25 mg tablet
- Mirabegron 50 mg tablet
The therapeutic interchange for BOTH mirabegron and vibegron will be REMOVED from System P&T Policy.
Vibegron will no longer be automatically interchanged at admission, but may be interchanged manually after an assessment of risks/benefits and pursuant to an inpatient order.
Formulary/Epic changes will Go-Live on Tuesday, March 7, 2023.