OBJECTIVES: To assess the prescribing, switching, and dose-adjustment patterns of overactive bladder (OAB) drugs in a real-world patient population METHODS: A retrospective analysis was conducted using the Medstat Marketscan databases, which contain pharmacy claims for 28 million individuals across the US. Study patients received an OAB drug prescription between April 1, 2009 and April 30, 2010 with continuous enrollment 6 months before the index date. Demographics, diagnosis rate, prescription fill dates, patients who switched to or from a given OAB drug, and patients adjusting dosage were evaluated. RESULTS: A total of 214,721 patients had an OAB prescription (mean age 65 y, 76% women), 23% were diagnosed with OAB; 37% of patients resided in Southern, 35% in Northern Central, 18% in Western, and 9% in Northeastern regions of the United States. Many patients switched drug therapy during the study period; those receiving drugs with multiple dose options appeared to have often made dose adjustments rather than switching to a new agent (Table). For example, among patients prescribed solifenacin, 22% of switches were to increase the dose and 39% were to decrease the dose. The proportion of patients switching to another agent was higher among those receiving oxybutynin, tolterodine ER, and solifenacin than with fesoterodine, darifenacin, and trospium. Among 32,782 (15%) patients who switched OAB medication at least once, the median (range) duration of time between filling their initial prescription and either dose-adjusting or switching to a new agent was 139 (0–393) days and they filled a median (range) of 4 (2–41) prescriptions before dose-adjusting or switching. CONCLUSIONS: In this real-world population, patients take advantage of the ability to adjust between multiple doses of drugs for which a flexible-dose treatment option is available. Many patients switched drug therapy, which suggests an opportunity to improve management of these patients and to identify an optimal treatment pathway.