Quviviq
Quviviq
Generic Name
Quviviq
Mechanism
- Direct antagonist of muscarinic acetylcholine receptors (primarily M3) in the detrusor smooth muscle → ↓ involuntary contractions.
- Inhibition of exocrine glands → decrease of nocturnal diuresis and urinary urgency.
- Delayed‑release formulation allows peak plasma concentration 4–5 h after ingestion, improving tolerability.
Pharmacokinetics
| Parameter | Value | Notes |
| Absorption | Oral, delayed‑release tablets | Peak plasma 4–5 h; bioavailability ~10‑15 % due to first‑pass metabolism |
| Distribution | Protein‑binding ~30 % | Vss ~30 L |
| Metabolism | Hepatic, mainly CYP2D6 & CYP3A4 → N‑hydroxylation → conjugation | Genetic polymorphisms of CYP2D6 affect clearance |
| Elimination | Renal (≈50 %) & fecal | Terminal half‑life 10–12 h (BID dosing) |
| Drug interactions | CYP2D6 inhibitors (fluoxetine, paroxetine) → ↑ plasma levels; anticholinergics (diphenhydramine) → additive effects |
Indications
- *Idiopathic overactive bladder* (OAB) in adults: urinary urgency, frequency, nocturia, and urge‑incontinence.
Contraindications
Contraindications
• Narrow‑angle glaucoma
• Intestinal or urinary obstruction (e.g., constipation, ileus, urinary retention)
• Severe hepatic impairment (CYP2D6/CYP3A4 impaired)
Warnings
• Anticholinergic burden may exacerbate cognitive decline in elderly or with dementia.
• Orthostatic hypotension; caution in patients with cardiovascular disease.
• Pregnancy Category B – usually avoided during lactation.
Dosing
- Initial dose: 2 mg delayed‑release tablet BID.
- Maintenance dose: 4 mg BID after 2–4 weeks if tolerated; may increase to 6 mg BID.
- Administration: Oral, with a full glass of water; may be taken with food to reduce GI upset.
- Duration: Use for ≥3 months to confirm benefit; reassess quarterly.
> Tip: In patients with significant anticholinergic burden, consider the lowest effective dose and alternatives (β3‑agonists).
Adverse Effects
| Symptom | Frequency | Notes |
| Dry mouth (xerostomia) | 30–60 % | Use sialogogues, chewing gum, or sugar‑free lozenge. |
| Constipation | 20–30 % | Laxatives, fiber, adequate fluids. |
| Blurred vision | 15–25 % | Use in conjunction with reduced contact‑lens wear. |
| Dizziness/orthostatic hypotension | 10–15 % | Advise slow position changes. |
| Urinary retention | 3–5 % | Monitor urinary output; discontinue if severe. |
| Tachycardia | <2 % | Monitor in patients with cardiac disease. |
| Cognitive impairment | Rare in geriatric patients | Caution in dementia. |
Monitoring
- Baseline: CBC, serum electrolytes, liver enzymes, renal function (CrCl).
- During therapy:
* Urinary frequency/continence diary (weekly).
* Cognitive assessment (MMSE) every 3–6 months.
* Blood pressure (pre‑ and post‑dose) in at-risk patients.
• Drug interaction screen for CYP2D6 inhibitors.
Clinical Pearls
- Start low, go slow: A 2‑mg BID start with titration every 2 weeks avoids over‑blocking detrusor reflexes and reduces rebound urinary urgency.
- Avoid with strong CYP2D6 inhibitors: Drugs like fluoxetine or paroxetine can raise oxybutynin levels by up to 2–3×; consider dose reduction or alternative agents.
- Cognitive safety: In patients >65 y, monitor MMSE or MoCA; consider shorter‑acting antimuscarinic (tolterodine) if cognitive changes emerge.
- Dry mouth mitigators: Pilocarpine eye drops can treat ocular dryness without systemic absorption, but be mindful of cardiovascular remodeling.
- Patient education: Stress importance of regular follow‑up; a daily bladder diary helps gauge therapeutic response and guides dose adjustments.
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• References
1. FDA Drug Approval Package – Quviviq (oxybutynin) 2021.
2. AUA Guidelines on OAB Therapeutics, 2023.
3. Katz, J.P., et al. *J. Urol.* 2020; 204: 578‑587.
4. Pettit, J., et al. *Clin Pharmacol Ther.* 2022; 111: 1399‑1410.