Today's overactive-bladder evidence has a clean bedside use. Before defaulting to a familiar agent, name the dominant complaint and the competing risk: urgency and incontinence favour a beta-3 agonist; troublesome daytime frequency favours mirabegron; an older patient already carrying anticholinergic load is a reason to avoid tolterodine; and uncontrolled hypertension nudges away from mirabegron. The drug that suits the symptom and spares the patient's other risks beats the one you reach for out of habit.
- Urgency and incontinence → beta-3 agonist (vibegron ranked best)
- Daytime frequency → mirabegron, if blood pressure allows
- High anticholinergic burden or older patient → avoid tolterodine
- Uncontrolled hypertension → avoid mirabegron
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