Drugs
If diet and lifestyle changes, bladder training and pelvic floor exercises do not provide sufficient benefit, then drug therapy can be prescribed in primary care. For postmenopausal women, vaginal estrogen can be very effective for the symptoms of Overactive bladder (OAB) and will help the common problem of vaginal dryness and discomfort as well.
Antimuscarinics/anticholinergics can be used for OAB and many are available. The problem with existing antimuscarinics is that OAB is a chronic disease and requires long-term therapy yet discontinuation rates are high, with one study showing >80% of patients on older antimuscarinic therapy stopping treatment at less than 6 months (Ref 6). Patients should be warned that side effects may occur such as dry mouth, constipation, fatigue, weight gain, insomnia and dizziness and if they persist, then trying a different drug is worthwhile.
One drug from the class of Beta3 agonists is available which acts in a different way to the antimuscarinics.
Duloxetine can be prescribed for stress incontinence but again, side effects may occur which may limit tolerability.
Antimuscarinics for OAB
| Drug | Dose | Cost per month |
| Extended-release oxybutinin (Lyrinel XL) | 5mg once daily, increasing by 5mg at weekly intervals, max 20mg daily | £13.77 for 30 tablets |
| Immediate-release oxybutinin (Ditropan) | Adults: 5mg 2, 3 or 4 times daily, max 20mg daily. Elderly: 2.5mg twice daily, increase to 5mg twice daily if necessary. |
£6.59 - £12.82 |
| Oxybutinin | Adults: 2.5mg 2 or 3 times daily, up to 5mg 4 times daily, max 20mg daily Elderly: 2.5mg twice daily, increase to 5mg twice daily if necessary |
2.5mg, 56 tabs: £2.44 3mg, 56 tabs: £14.00 5mg, 56 tabs: £3.14 |
| Trospium chloride (Regurin) | 20mg twice daily before meals | £26.00 |
| Extended release Trospium (Regurin XL) | 60mg once daily | £23.05 |
| Darifenacin (Emselex) | 7.5mg once daily increasing after 2 weeks to 15mg once daily if necessary | £20.90 for 28 |
| Solifencin (Vesicare) | 5mg once daily, increasing to 10mg once daily if necessary | £27.62 - £35.91 |
| Extended release tolterodine (Detrusitol XL) | 4mg once daily | £25.78 for 28 |
| Immediate release tolterodine (Detrusitol) | 1 – 2mg twice daily | £29.03 - £30.56 |
| Fesoterodine (Toviaz) | 4mg once daily, increasing to max 8mg once daily if necessary | £25.78 |
| Propiverine (Detrunorm) | 15mg once to 4 times daily | £18.00 for 56 |
| Propiverine extended release (Detrunorm XL) | 30mg once daily | £24.45 |
| Oxybutinin transdermal patch (Kentera patch) | 3.9mg per 24 hours transdermal patch, 1patch twice weekly | £27.20 |
Beta3 agonist
| Drug | Dose | Cost per month |
| Mirabegron (Betmiga) | 50mg once daily | 25mg £29.00 for 30 50mg £29.00 for 30 |
Stress Incontinence
| Drug | Dose | Cost per month |
| Duloxetine (Yentreve) | 40mg twice daily (May need to start at 20mg twice daily for 2 weeks) |
£36.96 (£18.48 for 28) |
Vaginal Estrogens
| Treatment | Dose | Cost |
| Vagifem vaginal tablet | 1 nightly for 2 weeks than 1 twice weekly | £16.72 for 24 |
| Gynest cream 0.01% | 1 vaginal applicator nightly for 2 weeks then 1 applicator twice weekly | £4.67 for 80g |
| Ovestin cream 0.1% | 1 vaginal applicator nightly for 2 weeks then 1 applicator twice weekly | £4.45 for 15g |
| Estring | 1 vaginal ring 3 monthly | £31.42 per ring |
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» Treatment options information for vaginal symptoms
