INTRODUCTION: Anticholinergic (AC) and beta-3 agonist (B3) medications are the mainstay of pharmacotherapy to treat overactive bladder (OAB). Recent clinical guidelines recommend cautious use of ACs in elderly patients as ACs are associated with cognitive side effects. The primary objective of this study was to examine OAB prescribing patterns from 2020 to 2022. METHODS: This is an IRB-approved retrospective study at a single academic center between January 2020 and December 2022. Women aged at least 18 years, diagnosed with OAB, and newly prescribed ACs or B3s were included. Overactive bladder diagnosis was identified using ICD-9 and -10 codes and the electronic medical record queried for new OAB medication prescriptions in our system. Patient demographics and clinician specialty were abstracted from the medical record. Group comparisons were conducted using Student's t-test, and χ2, Fisher's exact tests were used as appropriate. RESULTS: Five thousand six hundred forty-eight women were prescribed an AC or B3 between 2020 and 2022. Anticholinergic medications were more commonly prescribed, comprising 58.3% of OAB prescriptions compared to B3s (41.7%). Beta-3 agonist prescriptions increased by 127% over the study period. In contrast, AC prescribing remained stable. Women prescribed B3 agonists were more likely to be older (P<.001). There were significant differences in OAB prescription trends by prescriber specialty (P<.001). Urogynecologists were the leading prescribers of B3s (38.3%), whereas primary care clinicians prescribed the most ACs (57.9%). CONCLUSION: Beta-3 agonist prescriptions increased while AC prescriptions were relatively unchanged from 2020 to 2022. Despite growing concern regarding AC risks, our study shows that ACs are still prescribed at high volume.