Medication for Urinary Incontinence

Solifenacin

Drug Class

Urinary antispasmodics (anticholinergics).

Available as

Tablets, solifenacin succinate 5mg, 10mg.

Description

5mg, round, light yellow, film-coated tablets marked with '150' and the company logo on one side. 10mg, round, light pink, film-coated tablets marked with '151' and the company logo on one side.

Indications

Symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome.

Adult Dose

Recommended dose, 5mg once daily. Dose may be increased to 10mg once daily if required.

Child dose

Not recommended in children or adolescents.

Contraindications

Urinary retention, severe gastrointestinal condition (including toxic megacolon), myasthenia gravis or narrow angle glaucoma, and patients at risk of these conditions. Hypersensitivity to the active substance or to any of the excipients. Haemodialysis. Severe hepatic impairment. Patients with severe renal impairment or moderate hepatic impairment and who are on treatment with a potent CYP3A4 inhibitor (eg, ketoconazole). Lactation.

Special Precautions

Severe renal impairment, moderate hepatic impairment, concurrent administration with ketoconazole or other potent CYP3A4 inhibitors; maximum dose, 5mg. Assess other causes of frequent urination (heart failure or renal disease) before initiating treatment. Treat UTI if present. Use with caution in patients with clinically significant bladder outflow obstruction at risk of urinary retention, gastrointestinal obstructive disorders, risk of decreased gastrointestinal motility, hiatus hernia/gastro-oesophageal reflux and/or who are currently taking medicines that can cause or exacerbate oesophagitis (eg, bisphosphonates), autonomic neuropathy. Neurogenic cause for detrusor overactivity; safety and efficacy have not been established. Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Vesicare. Pregnancy.

Interactions

Other anticholinergics, cholinergic receptor agonists, gastrointestinal motility stimulants (eg, metoclopramide, cisapride), potent CYP3A4 inhibitors (eg, ketoconazole, ritonavir, nelfinavir, itraconazole), CYP3A4 inducers (eg, rifampicin, phenytoin, carbamazepine), other CYP3A4 substrates with higher affinity (eg, verapamil, diltiazem).

Adverse Drug Reactions

Most commonly, dry mouth. Commonly, constipation, nausea, dyspepsia, abdominal pain, blurred vision. Uncommonly, gastro-oesophageal reflux diseases, dry throat, urinary tract infection, cystitis, somnolence, dysgeusia, dry eyes, fatigue, lower limb oedema, nasal dryness, dry skin, difficulty in micturition. Rarely, colonic obstruction, faecal impaction, urinary retention.

Duloxetine

Drug Class

5HT/noradrenaline (norepinephrine) reuptake inhibitors.

Available as

Capsules, duloxetine (as hydrochloride) 20mg, 40mg.

Description

Hard, gastro-resistant capsules: 20mg, opaque blue marked with '9544'; 40mg, opaque orange marked with '9545'.

Price

20mg, 56 = £30.80.
40mg, 56 = £30.80.

Indications

Moderate to severe stress urinary incontinence (SUI) in women.

Adult Dose

Recommended dose, 40mg twice daily without regard to meals. Reassess after two to four weeks; in women experiencing troublesome adverse effects beyond four weeks, dose may be reduced to 20mg twice daily although limited data are available to support the efficacy of this lower dose. Reassess benefits of treatment at regular intervals.

Child dose

Not recommended.

Contraindications

Hypersensitivity to duloxetine or to any of the excipients. Liver disease resulting in hepatic impairment. Pregnancy and lactation. Concomitant administration with monoamine oxidase inhibitors (MAOIs) or within 14 days of their discontinuation; allow five days after stopping Yentreve therapy before starting an MAOI. Concomitant administration with CYP1A2 inhibitors (eg, fluvoxamine, ciprofloxacin).

Special Precautions

Recommended that consideration is given to combining Yentreve therapy with a pelvic floor muscle training programme as this may be more effective than either treatment alone. Use with caution in the elderly, patients with a history of mania or a diagnosis of bipolar disorder and/or seizures, patients with increased intraocular pressure, or those at risk of acute narrow angle glaucoma, patients with known bleeding tendencies. After more than one week of therapy, recommended to withdraw gradually. Capsules contain sucrose.

Interactions

MAOIs, CYP1A2 inhibitors (concomitant use contraindicated). Other antidepressants (including SSRIs, tricyclic antidepressants, venlafaxine, tryptophan), tramadol, anticoagulants, medicines known to affect platelet function, other CNS depressants, alcohol, CYP2D6 substrates with a narrow therapeutic index.

Adverse Drug Reactions

Very commonly, insomnia, nausea, dry mouth, constipation, fatigue. Commonly, anorexia, decreased appetite, thirst, sleep disorder, anxiety, decreased libido, anorgasmia, headache, dizziness (except vertigo), somnolence, tremor, blurred vision, nervousness, diarrhoea, vomiting, dyspepsia, increased sweating, lethargy, pruritus, weakness. Uncommonly, loss of libido.