HIGHLIGHTS OF PRESCRIBING INFORMATION Administration These highlights do not include all the information needed to use • MYRBETRIQ: ® ® MYRBETRIQ /MYRBETRIQ GRANULES safely and effectively. See o Adult patients: Swallow MYRBETRIQ whole with water. Do not full prescribing information for MYRBETRIQ/MYRBETRIQ chew, divide, or crush. Take with or without food. (2.7) GRANULES. o Pediatric patients: Swallow MYRBETRIQ whole with water. Do not chew, divide, or crush. Take with food. (2.7) MYRBETRIQ (mirabegron extended-release tablets), for oral use • MYRBETRIQ Granules: MYRBETRIQ GRANULES (mirabegron for extended-release oral o Pediatric patients: Take MYRBETRIQ Granules prepared as an suspension) extended-release oral suspension. Take with food. (2.7) Initial U.S. Approval: 2012 ------DOSAGE FORMS AND STRENGTHS ------RECENT MAJOR CHANGES ------• Extended-release tablets: 25 mg and 50 mg (3) Indications and Usage (1.2) 3/2021 • For extended-release oral suspension: 8 mg/mL of mirabegron after Dosage and Administration (2) 3/2021 reconstitution (3) Warnings and Precautions, Increase in Blood Pressure (5.1) 3/2021 ------CONTRAINDICATIONS ------INDICATIONS AND USAGE ------Hypersensitivity to mirabegron or any inactive ingredients. (4) MYRBETRIQ is a beta-3 agonist indicated for the treatment of: • (OAB) in adult patients with symptoms of urge ------WARNINGS AND PRECAUTIONS ------urinary incontinence, urgency, and urinary frequency, either alone or in • Increases in Blood Pressure: Can increase blood pressure in adult or combination with the succinate. (1.1) pediatric patients. Periodically monitor blood pressure, especially in • Neurogenic detrusor overactivity (NDO) in pediatric patients aged hypertensive patients. MYRBETRIQ/MYRBETRIQ Granules are not 3 years and older and weighing 35 kg or more. (1.2) recommended in patients with severe uncontrolled . (5.1) MYRBETRIQ Granules is a beta-3 indicated for the • in Patients With Bladder Outlet Obstruction and in treatment of NDO in pediatric patients aged 3 years and older. (1.2) Patients Taking Muscarinic Antagonist Drugs for Overactive Bladder: Administer with caution in these patients because of risk of urinary ------DOSAGE AND ADMINISTRATION ------retention. (5.2) • MYRBETRIQ and MYRBETRIQ Granules are two different products • : Angioedema of the face, lips, tongue, and/or larynx has and they are not substitutable on a milligram-per-milligram basis. Select been reported with mirabegron. (5.3, 6.2) the recommended product (MYRBETRIQ or MYRBETRIQ Granules) based on the indication and patient’s weight. Do not combine ------ADVERSE REACTIONS ------MYRBETRIQ and MYRBETRIQ Granules to achieve the total dose. A • Most commonly reported adverse reactions with MYRBETRIQ recommended dosage for MYRBETRIQ Granules for adults has not monotherapy in adult patients with OAB (> 2% and > placebo) were been determined. (2.1) hypertension, nasopharyngitis, , and headache. OAB in Adults (6.1) • The recommended starting dose of MYRBETRIQ is 25 mg orally once • Most commonly reported adverse reactions with MYRBETRIQ, in daily, either alone or in combination with solifenacin succinate 5 mg combination with solifenacin succinate in adult patients with OAB orally once daily. (2.2) (> 2% and > placebo and > comparator), were dry mouth, urinary tract • After 4 to 8 weeks, the MYRBETRIQ dose may be increased to 50 mg infection, constipation, and tachycardia. (6.1) orally once daily. (2.2) • Most commonly reported adverse reactions with NDO in Pediatric Patients 3 Years and Older MYRBETRIQ/MYRBETRIQ Granules in pediatric patients with NDO • Pediatric Patients weighing less than 35 kg: Use MYRBETRIQ (≥ 3%) were UTI, nasopharyngitis, constipation, and headache. (6.1) Granules: The recommended starting dose of MYRBETRIQ Granules is weight-based and administered as an extended-release oral suspension To report SUSPECTED ADVERSE REACTIONS, contact Astellas once daily. After 4 to 8 weeks, increase to the lowest effective dose Pharma US, Inc. at 1-800-727-7003 or FDA at 1-800-FDA-1088 or without exceeding the maximum recommended dose. (2.3) www.fda.gov/medwatch. • Pediatric Patients weighing 35 kg or more: Use MYRBETRIQ or MYRBETRIQ Granules: ------DRUG INTERACTIONS ------o The recommended starting dosage of MYRBETRIQ is 25 mg • Drugs Metabolized by CYP2D6: Mirabegron is a CYP2D6 inhibitor orally once daily. After 4 to 8 weeks, the MYRBETRIQ dose may and, when used concomitantly with drugs metabolized by CYP2D6, be increased to 50 mg orally once daily. (2.3) especially narrow therapeutic index drugs, appropriate monitoring and o The recommended starting dosage of MYRBETRIQ Granules, possible dose adjustment of those drugs may be necessary. (5.4, 7.1, administered as an extended-release oral suspension, is 6 mL 12.3) (48 mg) orally once daily. After 4 to 8 weeks, increase to a • Digoxin: When initiating a combination of mirabegron and digoxin with maximum dosage of MYRBETRIQ Granules 10 mL (80 mg) or without solifenacin succinate, use the lowest dose of digoxin; monitor orally once daily (2.3) serum digoxin concentrations to titrate digoxin dose to desired clinical Adult or Pediatric Patients with Renal or Hepatic Impairment: Refer to the full effect. (7.2, 12.3) prescribing information for recommended dosage. (2.4, 2.5) Preparation for MYRBETRIQ Granules: Refer to the full prescribing See 17 for PATIENT COUNSELING INFORMATION and FDA- information. (2.6) approved patient labeling.

Revised: 4/2021

FULL PRESCRIBING INFORMATION: CONTENTS* 1 INDICATIONS AND USAGE 8 USE IN SPECIFIC POPULATIONS 1.1 Adult Overactive Bladder (OAB) 8.1 Pregnancy 1.2 Pediatric Neurogenic Detrusor Overactivity (NDO) 8.2 Lactation 2 DOSAGE AND ADMINISTRATION 8.4 Pediatric Use 2.1 Important Dosage Information 8.5 Geriatric Use 2.2 Recommended Dosage for Adult Patients with OAB 8.6 Renal Impairment 2.3 Recommended Dosage for Pediatric Patients Aged 3 Years and Older 8.7 Hepatic Impairment with NDO 10 OVERDOSAGE 2.4 Recommended Dosage in Adult Patients with Renal or Hepatic 11 DESCRIPTION Impairment 12 CLINICAL PHARMACOLOGY 2.5 Recommended Dosage in Pediatric Patients with Renal or Hepatic 12.1 Mechanism of Action Impairment 12.2 Pharmacodynamics 2.6 Preparation and Storage Instructions for MYRBETRIQ Granules 12.3 2.7 Administration Instructions 13 NONCLINICAL TOXICOLOGY 2.8 Missed Dose 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 3 DOSAGE FORMS AND STRENGTHS 14 CLINICAL STUDIES 4 CONTRAINDICATIONS 14.1 MYRBETRIQ Monotherapy for Adult OAB 5 WARNINGS AND PRECAUTIONS 14.2 MYRBETRIQ Combination Therapy for Adult OAB 5.1 Increases in Blood Pressure 14.3 MYRBETRIQ/MYRBETRIQ Granules for Pediatric Neurogenic 5.2 Urinary Retention in Patients with Bladder Outlet Obstruction and in Detrusor Overactivity (NDO) Patients Taking Muscarinic Antagonist for OAB 16 HOW SUPPLIED/STORAGE AND HANDLING 5.3 Angioedema 16.1 MYRBETRIQ (mirabegron extended-release tablets) 5.4 Patients Taking Drugs Metabolized by CYP2D6 16.2 MYRBETRIQ Granules (mirabegron for extended-release oral 6 ADVERSE REACTIONS suspension) 6.1 Clinical Trials Experience 17 PATIENT COUNSELING INFORMATION 6.2 Postmarketing Experience 7 DRUG INTERACTIONS 7.1 Drugs Metabolized by CYP2D6 7.2 Digoxin 7.3 Warfarin *Sections or subsections omitted from the full prescribing information are not listed.

FULL PRESCRIBING INFORMATION 1 INDICATIONS AND USAGE

1.1 Adult Overactive Bladder (OAB) MYRBETRIQ Monotherapy MYRBETRIQ® is indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.

MYRBETRIQ Combination Therapy with Solifenacin Succinate MYRBETRIQ, in combination with the muscarinic antagonist solifenacin succinate, is indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.

1.2 Pediatric Neurogenic Detrusor Overactivity (NDO) MYRBETRIQ Granules MYRBETRIQ® Granules is indicated for the treatment of NDO in pediatric patients aged 3 years and older.

MYRBETRIQ MYRBETRIQ is indicated for the treatment of NDO in pediatric patients aged 3 years and older and weighing 35 kg or more. 2 DOSAGE AND ADMINISTRATION

2.1 Important Dosage Information MYRBETRIQ and MYRBETRIQ Granules are two different products and they are not substitutable on a milligram-per- milligram basis:

• Select the recommended product (MYRBETRIQ or MYRBETRIQ Granules) based on the indication and patient’s weight [see Indications and Usage (1) and Dosage and Administration (2.2, 2.3, 2.4, 2.5)]. • Do not combine MYRBETRIQ and MYRBETRIQ Granules to achieve the total dose. • A recommended dosage for MYRBETRIQ Granules for adults has not been determined.

2.2 Recommended Dosage for Adult Patients with OAB MYRBETRIQ Monotherapy The recommended starting dosage of MYRBETRIQ is 25 mg orally once daily. If needed, increase to the maximum dosage of MYRBETRIQ 50 mg orally once daily after 4 to 8 weeks. For administration instructions, see Dosage and Administration (2.7).

MYRBETRIQ Combination Therapy with Solifenacin Succinate The recommended starting dosage for combination treatment is MYRBETRIQ 25 mg orally once daily and solifenacin succinate 5 mg orally once daily. If needed, increase to the maximum dosage of MYRBETRIQ 50 mg orally once daily after 4 to 8 weeks. Refer to the Prescribing Information for solifenacin succinate for additional information. For administration instructions, see Dosage and Administration (2.7).

2.3 Recommended Dosage for Pediatric Patients Aged 3 Years and Older with NDO For pediatric patients 3 years of age and older, select the appropriate product (MYRBETRIQ or MYRBETRIQ Granules) based on the patient’s weight.

Pediatric Patients weighing less than 35 kg: Use MYRBETRIQ Granules The recommended starting and maximum doses of MYRBETRIQ Granules, administered as extended-release oral suspension once daily [see Dosage and Administration (2.6)], are shown in Table 1. The recommended dosages are determined based on patient weight. Evaluate patients periodically for potential dosage adjustment. For administration instructions, see Dosage and Administration (2.7).

Table 1: MYRBETRIQ Granules Recommended Dosage for Pediatric Patients Aged 3 Years and Older Weighing Less Than 35 kg as an Extended-Release Oral Suspension (Administered Orally Once Daily)

Body Weight Range Starting Dose Maximum Volume 11 kg to less than 22 kg 3 mL (24 mg) 6 mL (48 mg) 22 kg to less than 35 kg 4 mL (32 mg) 8 mL (64 mg) Greater than or equal to 35 kg Refer to information in next section

Pediatric Patients weighing 35 kg or more: Use MYRBETRIQ or MYRBETRIQ Granules The recommended starting dosage of MYRBETRIQ is 25 mg orally once daily. If needed, increase to a maximum dosage of MYRBETRIQ 50 mg orally once daily after 4 to 8 weeks. For administration instructions, see Dosage and Administration (2.7).

The recommended starting dosage of MYRBETRIQ Granules is 6 mL (48 mg) orally once daily. If needed, increase to a maximum dosage of MYRBETRIQ Granules 10 mL (80 mg) orally once daily after 4 to 8 weeks. For administration instructions, see Dosage and Administration (2.7). 2.4 Recommended Dosage in Adult Patients with Renal or Hepatic Impairment Dosage in Adults with Renal Impairment The recommended dosage of MYRBETRIQ (administered orally once daily) in adult patients with renal impairment is described in Table 2 [see Use in Specific Populations (8.6)]. For administration instructions, see Dosage and Administration (2.7).

Table 2: MYRBETRIQ Recommended Dosage in Adult Patients with Renal Impairment (Administered Orally Once Daily)

Estimated GFR1 Starting Dose Maximum Dose eGFR 30 to 89 mL/min/1.73 m2 25 mg 50 mg eGFR 15 to 29 mL/min/1.73 m2 25 mg 25 mg eGFR < 15 mL/min/1.73 m2 or requiring dialysis Not recommended 1. Estimated GFR using the modification of diet in renal disease (MDRD) formula

Dosage in Adults with Hepatic Impairment The recommended dosage of MYRBETRIQ (administered orally once daily) in adult patients with hepatic impairment is described in Table 3 [see Use in Specific Populations (8.7)]. For administration instructions, see Dosage and Administration (2.7).

Table 3: MYRBETRIQ Recommended Dosage in Adult Patients with Hepatic Impairment (Administered Orally Once Daily)

Hepatic Impairment Classification Starting Dose Maximum Dose Child-Pugh Class A (Mild hepatic impairment) 25 mg 50 mg Child-Pugh Class B (Moderate hepatic impairment) 25 mg 25 mg Child-Pugh Class C (Severe hepatic impairment) Not Recommended

2.5 Recommended Dosage in Pediatric Patients with Renal or Hepatic Impairment For pediatric patients 3 years of age and older, select the appropriate product (MYRBETRIQ or MYRBETRIQ Granules) based on the patient’s weight.

Pediatric Patients Weighing Less Than 35 kg with Renal or Hepatic Impairment: Use MYRBETRIQ Granules Dosage in Pediatric Patients with Renal Impairment The recommended dosage of MYRBETRIQ Granules in pediatric patients with renal impairment (administered orally once daily) is described in Table 4 [see Use in Specific Populations (8.6)]. For administration instructions, see Dosage and Administration (2.7).

Table 4: MYRBETRIQ Granules Recommended Dosage in Pediatric Patients Aged 3 Years and Older Weighing Less Than 35 kg with Renal Impairment (Administered Orally Once Daily)

Estimated GFR1 Body Weight Range Starting Dose Maximum Dose 11 kg to less than 22 kg 3 mL (24 mg) 6 mL (48 mg) eGFR 30 to 89 mL/min/1.73 m2 22 kg to less than 35 kg 4 mL (32 mg) 8 mL (64 mg) 11 kg to less than 22 kg 3 mL (24 mg) 3 mL (24 mg) eGFR 15 to 29 mL/min/1.73 m2 22 kg to less than 35 kg 4 mL (32 mg) 4 mL (32 mg) eGFR < 15 mL/min/1.73 m2 or undergoing dialysis Use is Not Recommended 1. Estimate GFR using a validated eGFR estimating equation for the pediatric age range of the approved indication. Dosage in Pediatric Patients with Hepatic Impairment The recommended dosage of MYRBETRIQ Granules in pediatric patients with hepatic impairment (administered orally once daily) is described in Table 5 [see Use in Specific Populations (8.7)]. For administration instructions, see Dosage and Administration (2.7).

Table 5: MYRBETRIQ Granules Recommended Dosage in Pediatric Patients Aged 3 Years and Older Weighing Less Than 35 kg with Hepatic Impairment (Administered Orally Once Daily)

Hepatic Impairment Classification Body Weight Range Starting Dose Maximum Dose 11 kg to less than 22 kg 3 mL (24 mg) 6 mL (48 mg) Child-Pugh Class A (Mild hepatic impairment) 22 kg to less than 35 kg 4 mL (32 mg) 8 mL (64 mg) 11 kg to less than 22 kg 3 mL (24 mg) 3 mL (24 mg) Child-Pugh Class B (Moderate hepatic impairment) 22 kg to less than 35 kg 4 mL (32 mg) 4 mL (32 mg) Child-Pugh Class C (Severe hepatic impairment) Use is Not Recommended

Pediatric Patients weighing 35 kg or more with renal or hepatic impairment: Use MYRBETRIQ or MYRBETRIQ Granules Dosage in Pediatric Patients with Renal Impairment The recommended dosage of MYRBETRIQ in pediatric patients with renal impairment weighing 35 kg or more (administered orally once daily) is described in Table 2 (above). Note that the dosage is the same as for adult patients with renal impairment [see Dosage and Administration (2.4) and Use in Specific Populations (8.6)]. For administration instructions, see Dosage and Administration (2.7).

The recommended dosage of MYRBETRIQ Granules in pediatric patients with renal impairment weighing 35 kg or more (administered orally once daily) is described in Table 6 [see Use in Specific Populations (8.6)]. For administration instructions, see Dosage and Administration (2.7).

Table 6: MYRBETRIQ Granules Recommended Dosage in Pediatric Patients Aged 3 Years and Older with Renal Impairment Weighing 35 kg or More (Administered Orally Once Daily)

Estimated GFR1 Starting Dose Maximum Dose eGFR 30 to 89 mL/min/1.73 m2 6 mL (48 mg) 10 mL (80 mg) eGFR 15 to 29 mL/min/1.73 m2 6 mL (48 mg) 6 mL (48 mg) eGFR < 15 mL/min/1.73 m2 or undergoing dialysis Use is Not Recommended 1. Estimate GFR using a validated eGFR estimating equation for the pediatric age range of the approved indication.

Dosage in Pediatric Patients with Hepatic Impairment The recommended dosage of MYRBETRIQ in pediatric patients with hepatic impairment weighing 35 kg or more (administered orally once daily) is described in Table 3 (above). Note that the dosage is the same as for adult patients with hepatic impairment [see Dosage and Administration (2.4) and Use in Specific Populations (8.6)]. For administration instructions, see Dosage and Administration (2.7).

The recommended dosage of MYRBETRIQ Granules in pediatric patients with hepatic impairment weighing 35 kg or more (administered orally once daily) is described in Table 7 [see Use in Specific Populations (8.7)]. For administration instructions, see Dosage and Administration (2.7).

Table 7: MYRBETRIQ Granules Recommended Dosage in Pediatric Patients Aged 3 Years and Older with Hepatic Impairment Weighing 35 kg or More (Administered Orally Once Daily)

Hepatic Impairment Classification Starting Dose Maximum Dose Child-Pugh Class A (Mild hepatic impairment) 6 mL (48 mg) 10 mL (80 mg) Child-Pugh Class B (Moderate hepatic impairment) 6 mL (48 mg) 6 mL (48 mg) Child-Pugh Class C (Severe hepatic impairment) Use is Not Recommended 2.6 Preparation and Storage Instructions for MYRBETRIQ Granules The required dose for MYRBETRIQ Granules (mirabegron for extended-release oral suspension) is calculated based on the weight of the patient. Prepare oral suspension at the time of dispensing.

Keep the bottle in the pouch up until the time of reconstitution.

• Discard the pouch and desiccant prior to reconstitution. Do not dispense. • Tap the closed bottle several times to loosen the granules. • Measure 100 mL of water, add the total amount to the bottle, and immediately shake vigorously for 1 minute, then let it stand for 10 to 30 minutes. Shake vigorously again for 1 minute. • If granules have not dispersed, shake vigorously for another 1 minute. • Record the 28-day expiration date on the container and carton based on the reconstitution date. • Give the patient an appropriate dosing device. • Store the reconstituted suspension at 20°C to 25°C (68°F to 77°F) for up to 28 days. • Discard the unused portion after 28 days [see How Supplied/Storage and Handling (16.2)].

After reconstitution with 100 mL water, the suspension contains 8 mg/mL of mirabegron.

2.7 Administration Instructions Administration instructions for MYRBETRIQ and MYRBETRIQ Granules differ based on the patient population.

MYRBETRIQ Adult patients: Swallow MYRBETRIQ whole with water. Do not chew, divide, or crush. Take with or without food. Pediatric patients: Swallow MYRBETRIQ whole with water. Do not chew, divide, or crush. Take with food [see Use in Specific Populations (8.4)].

MYRBETRIQ Granules Adult patients: A recommended dosage for MYRBETRIQ Granules for adults has not been determined. Pediatric patients: Take MYRBETRIQ Granules prepared as an extended-release oral suspension [see Dosage and Administration (2.6)]. Take with food to reduce potential exposure-related risks [see Use in Specific Populations (8.4)].

2.8 Missed Dose Instruct patients to take any missed doses as soon as they remember, unless more than 12 hours have passed since the missed dose. If more than 12 hours have passed, the missed dose can be skipped, and the next dose should be taken at the usual time.

3 DOSAGE FORMS AND STRENGTHS

MYRBETRIQ (mirabegron extended-release tablets) are supplied in two different strengths as described below:

• 25 mg oval, brown, film-coated , debossed with the (Astellas logo) and “325” • 50 mg oval, yellow, film-coated tablet, debossed with the (Astellas logo) and “355”

MYRBETRIQ Granules (mirabegron for extended-release oral suspension): Each bottle is filled with approximately 8.3 g of yellowish white granules, which contain 830 mg of mirabegron. After reconstitution with 100 mL water, the oral suspension is pale brownish yellow to yellow with 8 mg/mL of mirabegron.

4 CONTRAINDICATIONS

MYRBETRIQ/MYRBETRIQ Granules is contraindicated in patients with known hypersensitivity reactions to mirabegron or any inactive ingredients of the tablet or oral suspension [see Adverse Reactions (6.1, 6.2)]. 5 WARNINGS AND PRECAUTIONS

5.1 Increases in Blood Pressure Increases in Blood Pressure in Adults MYRBETRIQ/MYRBETRIQ Granules can increase blood pressure. Periodic blood pressure determinations are recommended, especially in hypertensive patients. MYRBETRIQ/MYRBETRIQ Granules is not recommended for use in patients with severe uncontrolled hypertension (defined as systolic blood pressure greater than or equal to 180 mm Hg and/or diastolic blood pressure greater than or equal to 110 mm Hg) [see Clinical Pharmacology (12.2)].

In two, randomized, placebo-controlled, healthy adult volunteer studies, MYRBETRIQ was associated with dose-related increases in supine blood pressure. In these studies, at the maximum recommended dose of 50 mg, the mean maximum increase in systolic/diastolic blood pressure was approximately 3.5/1.5 mm Hg greater than placebo.

In contrast, in adult OAB patients in clinical trials, MYRBETRIQ, taken as monotherapy or in combination with solifenacin succinate 5 mg, the mean increase in systolic and diastolic blood pressure at the maximum recommended mirabegron dose of 50 mg was approximately 0.5 to 1 mm Hg greater than placebo. Worsening of pre-existing hypertension was reported infrequently in patients taking MYRBETRIQ.

Increases in Blood Pressure in Pediatric Patients 3 Years and Older MYRBETRIQ/MYRBETRIQ Granules can increase blood pressure in pediatric patients. Blood pressure increases may be larger in children (3 to less than 12 years of age) than in adolescents (12 to less than 18 years of age). Periodic blood pressure determinations are recommended. MYRBETRIQ/MYRBETRIQ Granules is not recommended for use in pediatric patients with severe uncontrolled hypertension, defined as a systolic and/or diastolic blood pressure above the 99th percentile plus 5 mm Hg for age, sex, and stature using appropriate reference values [see Adverse Reactions (6.1)].

5.2 Urinary Retention in Patients with Bladder Outlet Obstruction and in Patients Taking Muscarinic Antagonist Medications for OAB In patients taking MYRBETRIQ, urinary retention has been reported to occur in patients with bladder outlet obstruction (BOO) and in patients taking muscarinic antagonist medications for the treatment of OAB. A controlled clinical safety study in patients with BOO did not demonstrate increased urinary retention in patients treated with mirabegron; however, MYRBETRIQ should still be administered with caution to patients with clinically significant BOO. For example, monitor these patients for signs and symptoms of urinary retention. MYRBETRIQ should also be administered with caution to patients taking muscarinic antagonist medications for the treatment of OAB, including solifenacin succinate [see Clinical Pharmacology (12.2)].

5.3 Angioedema Angioedema of the face, lips, tongue, and/or larynx has been reported with MYRBETRIQ/MYRBETRIQ Granules. In some cases, angioedema occurred after the first dose, however, cases have been reported to occur hours after the first dose or after multiple doses. Angioedema, associated with upper airway swelling, may be life-threatening. If involvement of the tongue, hypopharynx, or larynx occurs, promptly discontinue MYRBETRIQ/MYRBETRIQ Granules and provide appropriate therapy and/or measures necessary to ensure a patent airway [see Adverse Reactions (6.2)].

5.4 Patients Taking Drugs Metabolized by CYP2D6 Since MYRBETRIQ/MYRBETRIQ Granules is a moderate CYP2D6 inhibitor, the systemic exposure to CYP2D6 substrates is increased when coadministered with MYRBETRIQ/MYRBETRIQ Granules. Therefore, appropriate monitoring and dose adjustment may be necessary, especially with narrow therapeutic index drugs metabolized by CYP2D6 [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)]. 6 ADVERSE REACTIONS

The following adverse reactions are discussed in more detail in other sections of the labeling.

• Hypertension [see Warnings and Precautions (5.1)] • Urinary Retention [see Warnings and Precautions (5.2)] • Angioedema [see Warnings and Precautions (5.3)]

6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

MYRBETRIQ Monotherapy for Adult OAB In three, 12-week, double-blind, placebo-controlled, safety and efficacy studies in patients with OAB (Studies 1, 2, and 3), MYRBETRIQ was evaluated for safety in 2736 patients [see Clinical Studies (14.1)]. Study 1 also included an active control. For the combined Studies 1, 2, and 3, 432 patients received MYRBETRIQ 25 mg, 1375 received MYRBETRIQ 50 mg, and 929 received MYRBETRIQ 100 mg once daily. In these studies, the majority of the patients were Caucasian (94%) and female (72%) with a mean age of 59 years (range 18 to 95 years).

MYRBETRIQ was also evaluated for safety in 1632 patients who received MYRBETRIQ 50 mg once daily (n=812 patients) or MYRBETRIQ 100 mg (n=820 patients) in a 1-year, randomized, fixed-dose, double-blind, active- controlled, safety study in patients with OAB (Study 4). Of these patients, 731 received MYRBETRIQ in a previous 12- week study. In Study 4, 1385 patients received MYRBETRIQ continuously for at least 6 months, 1311 patients received MYRBETRIQ for at least 9 months, and 564 patients received MYRBETRIQ for at least 1 year.

The most frequent adverse events (0.2%) leading to discontinuation in Studies 1, 2, and 3 for the 25 mg or 50 mg dose were nausea, headache, hypertension, diarrhea, constipation, dizziness, and tachycardia.

Atrial fibrillation (0.2%) and prostate cancer (0.1%) were reported as serious adverse events by more than 1 patient and at a rate greater than placebo.

Table 8 lists the adverse reactions, derived from all adverse events, that were reported in Studies 1, 2, and 3 at an incidence greater than placebo and in 1% or more of patients treated with MYRBETRIQ 25 mg or 50 mg once daily for up to 12 weeks. The most commonly reported adverse reactions (greater than 2% of MYRBETRIQ patients and greater than placebo) were hypertension, nasopharyngitis, urinary tract infection, and headache. Table 8: Percentages of Patients with Adverse Reactions, Derived from All Adverse Events, Exceeding Placebo Rate and Reported in ≥ 1% of OAB Patients Treated with MYRBETRIQ 25 mg or 50 mg Once Daily in Studies 1, 2, and 3

Placebo MYRBETRIQ 25 mg MYRBETRIQ 50 mg Adverse Reaction (%) (%) (%) Number of Patients 1380 432 1375 Hypertension1 7.6 11.3 7.5 Nasopharyngitis 2.5 3.5 3.9 Urinary Tract Infection 1.8 4.2 2.9 Headache 3.0 2.1 3.2 Constipation 1.4 1.6 1.6 Upper Respiratory Tract 1.7 2.1 1.5 Infection Arthralgia 1.1 1.6 1.3 Diarrhea 1.3 1.2 1.5 Tachycardia 0.6 1.6 1.2 Abdominal Pain 0.7 1.4 0.6 Fatigue 1.0 1.4 1.2 1. Includes reports of blood pressure above the normal range, and BP increased from baseline, occurring predominantly in subjects with baseline hypertension.

Other adverse reactions reported by less than 1% of patients treated with MYRBETRIQ in Studies 1, 2, or 3 included:

Cardiac disorders: palpitations, blood pressure increased [see Clinical Pharmacology (12.2)] Eye disorders: glaucoma [see Clinical Pharmacology (12.2)] Gastrointestinal disorders: dyspepsia, gastritis, Infections and Infestations: , Investigations: GGT increased, AST increased, ALT increased, LDH increased Renal and urinary disorders: nephrolithiasis, bladder pain Reproductive system and breast disorders: vulvovaginal pruritus, vaginal infection Skin and subcutaneous tissue disorders: urticaria, leukocytoclastic vasculitis, rash, pruritus, purpura, lip edema

Table 9 lists the rates of the most commonly reported adverse reactions, derived from all adverse events in patients treated with MYRBETRIQ 50 mg for up to 52 weeks in Study 4. The most commonly reported adverse reactions (> 3% of MYRBETRIQ patients) were hypertension, urinary tract infection, headache, and nasopharyngitis.

Table 9: Percentages of Patients with Adverse Reactions, Derived from All Adverse Events, Reported in > 2% of OAB Patients Treated with MYRBETRIQ 50 mg Once Daily in Study 4

MYRBETRIQ 50 mg Active Control Adverse Reaction (%) (%) Number of Patients 812 812 Hypertension 9.2 9.6 Urinary Tract Infection 5.9 6.4 Headache 4.1 2.5 Nasopharyngitis 3.9 3.1 Back Pain 2.8 1.6 Constipation 2.8 2.7 Dry Mouth 2.8 8.6 Dizziness 2.7 2.6 Sinusitis 2.7 1.5 Influenza 2.6 3.4 Arthralgia 2.1 2.0 Cystitis 2.1 2.3 In Study 4, in patients treated with MYRBETRIQ 50 mg once daily, adverse reactions leading to discontinuation reported by more than 2 patients and at a rate greater than active control included: constipation (0.9%), headache (0.6%), dizziness (0.5%), hypertension (0.5%), dry eyes (0.4%), nausea (0.4%), vision blurred (0.4%), and urinary tract infection (0.4%). Serious adverse events reported by at least 2 patients and exceeding active control included cerebrovascular accident (0.4%) and osteoarthritis (0.2%). Serum ALT/AST increased from baseline by greater than 10-fold in 2 patients (0.3%) taking MYRBETRIQ 50 mg; and these markers subsequently returned to baseline while both patients continued MYRBETRIQ.

In Study 4, serious adverse events of neoplasm were reported by 0.1%, 1.3%, and 0.5% of patients treated with MYRBETRIQ 50 mg, MYRBETRIQ 100 mg, and active control once daily, respectively. Neoplasms reported by 2 patients treated with MYRBETRIQ 100 mg included breast cancer, lung neoplasm malignant, and prostate cancer. A causal relationship between mirabegron and these reported neoplasms has not been established.

In a separate clinical study in Japan, a single case was reported as Stevens-Johnson syndrome with increased serum ALT, AST, and bilirubin in a patient taking MYRBETRIQ 100 mg as well as an herbal (Kyufu Gold).

MYRBETRIQ Combination Therapy with Solifenacin Succinate for Adult OAB In three, 12-week, double-blind, randomized, active-controlled safety and efficacy studies in patients with OAB (Studies 5, 6, and 7), combination treatment of MYRBETRIQ and solifenacin succinate was evaluated for safety in 6818 patients [see Clinical Studies (14.2)]. Studies 5 and 6 also included a placebo control. For the combined Studies 5, 6, and 7, 997 patients received combination treatment with MYRBETRIQ 25 mg and solifenacin succinate 5 mg, and 1706 patients received combination treatment with MYRBETRIQ 50 mg and solifenacin succinate 5 mg. In these studies, the majority of the patients were Caucasian (88%) and female (77%) with a mean age of 57 years (range 18 to 89 years).

MYRBETRIQ 50 mg and solifenacin succinate 5 mg coadministration was also evaluated for safety in 1814 patients in a 52-week, double-blind, randomized, active-controlled study in patients with OAB (Study 8) [see Clinical Studies (14.2)].

In Studies 5, 6, and 7, the most commonly reported adverse reactions (greater than 2% of patients treated with combination therapy of MYRBETRIQ and solifenacin succinate 5 mg, and greater than placebo and/or MYRBETRIQ or solifenacin succinate comparator at the same dose as in the combination treatment) were dry mouth, urinary tract infection, constipation, and tachycardia. The most frequent adverse reactions (≥ 0.2%) leading to discontinuation in the coadministration trials were dry mouth and urinary retention.

Table 10 lists the adverse reactions, derived from all adverse events that were reported in Studies 5, 6, and 7 in 1% or more of patients treated with MYRBETRIQ 25 mg or 50 mg coadministered with solifenacin succinate 5 mg and at an incidence greater than placebo and mirabegron or solifenacin succinate comparator at the same dose as in the combination treatment when administered once daily for up to 12 weeks. Table 10: Percentages of Patients with Adverse Reactions, Derived from All Adverse Events, Exceeding Placebo and Comparator (at same dose level) Rate and Reported in ≥ 1% of OAB Patients Treated with Combination Therapy in Studies 5, 6, and 71

MYRBETRIQ MYRBETRIQ Solifenacin 25 mg + Solifenacin 50 mg + Solifenacin Adverse MYRBETRIQ MYRBETRIQ Succinate Succinate Succinate Reaction Placebo 25 mg 50 mg 5 mg 5 mg 5 mg1 (%) (%) (%) (%) (%) (%) Number of 510 500 500 1288 997 1706 Patients Dry Mouth 2.2 3.8 3.6 6.5 9.3 7.2 Urinary Tract 5.3 4.0 4.2 3.6 7.0 4.0 Infections2 Constipation 1.2 1.2 2.8 2.4 4.2 3.9 Tachycardia 0.8 1.6 1.6 0.7 2.2 0.9 Dyspepsia 0.6 0.4 0.2 0.7 1.1 1.3 Dizziness 0.4 0.8 1.2 1.2 1.3 0.4 Vision Blurred 0.4 0.2 0.2 0.9 0.7 1.1 Arthralgia 0.8 0.8 0.8 0.8 0.5 1.1 1. Adverse reactions occurring in patients treated with coadministration of MYRBETRIQ and solifenacin succinate in Study 7, that included a 4-week initial treatment period with MYRBETRIQ 25 mg + Solifenacin Succinate 5 mg, are included in the MYRBETRIQ 50 mg + Solifenacin Succinate 5 mg group. 2. Includes any recorded treatment-emergent UTI.

In Study 8, the most common adverse reactions (more than 2% of patients treated with coadministration of MYRBETRIQ and solifenacin succinate and exceeding comparator rate) were UTI, dry mouth, constipation, and headache. The most frequent adverse reactions leading to discontinuation in the trial were constipation (0.2%), urinary retention (0.2%), urinary hesitation (0.2%), and vision blurred (0.2%).

In Study 8, serious adverse events of neoplasm were reported by 0.7%, 0.3%, and 0% of patients who received coadministration of MYRBETRIQ 50 mg and solifenacin succinate 5 mg, MYRBETRIQ 50 mg monotherapy, and solifenacin succinate 5 mg monotherapy, respectively. Neoplasms reported by more than 1 patient who received coadministration with MYRBETRIQ 50 mg and solifenacin succinate 5 mg included basal cell carcinoma (n=3), breast cancer (n=2), melanoma (n=2), and squamous cell carcinoma (n=2). A causal relationship between the coadministration of mirabegron and solifenacin succinate and these reported neoplasms has not been established.

Table 11 lists the adverse reactions, derived from all adverse events that were reported at an incidence greater than comparator and in 2% or more of patients treated with MYRBETRIQ 50 mg coadministered with solifenacin succinate 5 mg once daily for up to 52 weeks in Study 8.

Table 11: Percentages of Patients with Adverse Reactions, Derived from All Adverse Events, Exceeding Comparator Rate and Reported in ≥ 2% of OAB Patients Treated with Combination Therapy in Study 8

MYRBETRIQ MYRBETRIQ Solifenacin Succinate 50 mg + Solifenacin Succinate Adverse Reaction 50 mg 5 mg 5 mg (%) (%) (%) Number of Patients 305 303 1206 Urinary Tract Infections1 6.2 5.9 8.4 Dry Mouth 3.9 5.9 6.1 Constipation 1.0 2.3 3.3 Headache 1.6 1.7 2.9 1. Includes any recorded treatment-emergent UTI. MYRBETRIQ/MYRBETRIQ Granules for Pediatric Neurogenic Detrusor Overactivity (NDO) The safety of MYRBETRIQ/MYRBETRIQ Granule