Urinary frequency, enuresis and incontinence

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Patients’ response to drugs within this class is idiosyncratic. It may be necessary to try different drugs before a response occurs.  Mirabegron is the first beta-3 adrenoceptor agonist to treat symptoms of overactive bladder and offers an alternative where anticholinergics are either not tolerated or are ineffective.

For guidance on the management of urinary incontinence in women refer to www.nice.org.uk.

For local continence care guidance and continence products see the North Highland Community Catheter and Appliances Formulary.

SOLIFENACIN (First Line)

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 5mg, 10mg

Dosage:

5mg daily, increased if necessary after 3 to 4 weeks to 10mg once daily.

MIRABEGRON (Second Line)

Important: Therapy notes

MHRA advice: Mirabegron (Betmiga) risk of severe hypertension and associated cerebrovascular and cardiac events (October 2015) (www.gov.uk).

  • Alternative first-line if antimuscarinics are contraindicated.

Important: Formulation and dosage details

Formulation:

Modified release tablets 25mg, 50mg

Dosage:

50mg once daily.

For dosing in patients with renal or hepatic impairment in the absence or presence of strong cytochrome P450 inhibitors such as itraconazole, ketoconazole, ritonavir, or clarithromycin, refer to SPC.

OXYBUTYNIN

Important: Therapy notes

  • Side-effects limit the use of oxybutynin but may be reduced by starting at a lower dose.
  • Do not use oxybutynin in those aged over 70 years or those with cognitive impairment.
  • The modified-release preparation has fewer side-effects but is not always as effective as the immediate-release preparation.

Important: Formulation and dosage details

Formulation:

Tablets 2·5mg, 5mg

Dosage:

Initially 2·5 to 5mg 2 to 3 times daily increased if necessary to maximum 5mg 4 times daily

Important: Formulation and dosage details

Formulation:

Modified release tablets 5mg, 10mg

Dosage:

Modified release: 5mg daily, adjusted according to response in 5mg steps at weekly intervals, maximum 20mg daily taken as a single dose.