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. [2006]
  • 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]



  • 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
  • Capsules modified release 4mg


  • Tablets modified release 7.5mg, 15mg      


  • Tablets 20mg      


  • Tablets modified release 25mg, 50mg


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)


Return to Chapter: 7. Obstetrics, Gynaecology and Urinary–tract Disorders

Last updated by: Annie Bolton on 24-10-2016 09:34