7.4.2 Drugs for urinary frequency, enuresis, and incontinence
|First line drugs||Second line drugs||Specialist drugs||Secondary care drugs|
- Accurate assessment and diagnosis of the cause of incontinence is vital for treatment success. Non-drug treatments have an important role in management.
- Desmopressin (refer to Section 6.5.2) is licensed for nocturnal enuresis.
- Tricyclic antidepressants may also be used to treat nocturnal enuresis.
- Do not use flavoxate, propantheline and imipramine for the treatment of UI or OAB in women. 
Do not offer oxybutynin (immediate release) to frail older women. [new 2013]
Offer one of the following choices first to women with OAB or mixed UI:
oxybutynin (immediate release), or
tolterodine (immediate release), or
darifenacin (once daily preparation). [new 2013]
If the first treatment for OAB or mixed UI is not effective or well-tolerated, offer another drug with the lowest acquisition cost. [new 2013]
Offer a transdermal OAB drug to women unable to tolerate oral medication. [new 2013]
- NICE CG97 - Lower Urinary Tract Symptoms
- NICE CG171 - Urinary Incontinence - The management of urinary incontinence in women
- NICE Pathway - Overactive Bladder (November 2013)
- Tablets 2.5mg, 3mg, 5mg
Notes: Oxybutynin standard release is the first choice drug therapy. Patients may experience anticholinergic side effects. Therefore the minimum effective dose should be used. However, many patients referred to secondary care on low doses respond well to higher doses so GPs should consider increasing the dose of oxybutynin to 5mg TDS before referral.
- Tablets 1mg, 2mg
- Tablets m/r 7.5mg, 15mg
- Capsules m/r 4mg
- Tablets 20mg
- Tablets m/r, 50mg, 25 mg
To be used third-line in line with agreed pathway: Pharmacotherapy for the Management of LUTS in Males and Females
LUTS GP pathway: Pathway for the Management of LUTS in Males and Females
NICE TA290: Overactive bladder - mirabegron (June 2013)
Last updated by: Nikki Woodhall on 19-01-2015 14:34