New drugs and the
management of
incontinence
Stephen Mark
Drug therapy for incontinence
OAB: Anti cholinergics: different routes,
Oxytrol and more selective [ M3],
Tolteradine, Solifenacin, Darifenacin.
Extended formula’s, Ditropan XL . Botox
SUI: Duloxetine
Normal bladder function
Storage:
Bladder
Outlet
Emptying: Bladder
Outlet
Abnormal bladder
function
Storage: High P [ OAB ]
Treat: Bladder retraining
Drugs
Surgery
Affects men with BPH
Combination medication alpha
blocker and anticholinergic
being trialled
Bladder retraining
Effective
Durable
Minimum duration 2 months
Better results with Continence
therapist
Drug treatment: Aims
Lower pressure of bladder and
increase storage volume
Reduce sensitivity bladder
Minimal side effects
Acceptable costs
Drug utilisation is increasing
Drug treatment in OAB
Oxybutinin: [ Ditropan ]: Anticholinergic.
Direct smooth muscle relaxant [ M1,2,3] and local
anaesthetic. Non-selective agent. 70% effective but over
50% stop due to intolerable side effects [ dry mouth,
blurred vision, GI symptoms…]. Government funded .
 Most commonly used agent
New OAB Medication
Effectiveness
Side effects
Cost
Role
Newer drugs for OAB
Solifenacin
Tolteradine
Ditropan XL
Longer acting Oxybutinin formula
Rarely used in NZ
Similar effectiveness but less side effects
Oxytrol: Oxybutinin
patches
Available in NZ
Similar effectiveness but less side effects
Dose 2 patches per week
Cost: $ 80 - $120 per month
Comparison oral vs transdermal
Oxybutinin
Tolterodine [ Detrusitol]
M2 and M3 selective anticholinergic
studied in adults and children
similar effectiveness to Oxybutinin
less side effects
bid dose 2 to 4 mg
Cost: $ 80 - $ 120 per month
Comparison
Oxybutinin and
Tolteradine
Solifenacin [ Vesicare]
M3 selective anticholinergic
studied in adults
similar effectiveness to Oxybutinin
less side effects
once daily dose 5 or 10 mg
Cost: $ 80 - $120 per month
Cost of medication
$ 80 - $120 per month
dependant on pharmacy and location
occasional company discount
Darifenacin [Enablex]
M3 antagonist
not available in NZ
bid dose
Comparison M3 receptor
antagonists
Role of anticholinergics in NZ
Oxybutinin fully funded
All other drugs equal and similar efficacy
All other drugs less side effects
Pharmac unlikely to change
Dose escalation Oxybutinin to reduce side effects
[ except children]
Offer alternative if effective and significant side effects
Patient will need to pay
Duloxotine for SUI
Serotonin NE uptake inhibitor
anti depressant
10 RCT showing 50% effective in
reducing SUI….. Not curative
Improved Qol
Significant side effects [ 20% withdrawl]
Summary: No role in SUI treatment
The End