Urinary retention in patients with bladder outlet obstruction (BOO) and in patients taking antimuscarinic medications for the treatment of OAB has been reported in postmarketing experience in patients taking mirabegron. A controlled clinical safety study in patients with BOO did not demonstrate increased urinary retention in Myrbetriq patients; however, Myrbetriq should be administered with caution to patients with clinically significant BOO. Myrbetriq should also be administered with caution to patients taking antimuscarinic medications for the treatment of OAB.
A microdialysis study in rats concluded that modafinil inhibits striatal and pallidal GABA release 14 . Moreover, modafinil dose-dependently increases extracellular glutamate and enhances excitatory glutamatergic neurotransmission in the ventromedial (VMT), ventrolateral (VLT), thalamus and hippocampal regions of wild-type rats 15 . Hence, modafinil’s tendency to increase the glutamate/GABA ratio may account for some of its wake-promoting effects, although dopamine agonists and dopamine itself both elicit glutamate release in the hippocampus 16 , raising the possibility that increases in extracellular glutamate may arise secondarily from modafinil’s action on DA.