Overactive Bladder & Urinary Incontinence Treatments
| OVERACTIVE BLADDER & URINARY INCONTINENCE TREATMENTS† | |||||
|---|---|---|---|---|---|
| Generic & Class | Brand & Company | Formu- lation |
Strengths | Dose | Notes |
| ANTICHOLINERGIC | |||||
| Imipramine HCl | Tofranil
(Mallinckrodt) |
tabs | 10mg, 25mg, 50mg | <6 years: not recommended.
≥6 years: initially 25mg daily 1 hour before bedtime; after 1 week, increase to 50mg for children 6–12 years, up to 75mg for those >12 years. |
Attempt drug-free periods after gradual tapering of dose if drug response favorable. |
| Early night bedwetters: give 25mg in afternoon
and repeat at bedtime.
Max 2.5mg/kg per day. |
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| ANTISPASMODIC/ANTICHOLINERGIC | |||||
| Darifenacin HBr | Enablex
(Novartis) |
ext-rel tabs | 7.5mg, 15mg | Children: not recommended.
Adults: Initially 7.5mg once daily; may increase to 15mg once daily after 2 weeks. Max 7.5mg once daily in moderate hepatic impairment or with potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, ritonavir, nelfinavir, clarithromycin, nefazadone). |
Swallow whole with liquid. |
| Oxybutynin chloride | —
(various) |
scored tabs | 5 mg | <5yrs: not recommended.
≥5yrs: 5mg twice daily; max 15mg/day. Adults: 5mg 2–3 times a day; max 20mg/day. |
|
| —
(various) |
syrup | 5mg/5mL | |||
| Ditropan XL
(Janssen) |
ext-rel tabs | 5mg, 10mg, 15mg | <6yrs: not recommended.
≥6yrs: Initially 5mg once daily; may increase in 5mg increments; max 20mg/day. Adults: Initially 5mg or 10mg once daily; may increase weekly in 5mg increments; max 30mg/day. |
Swallow whole. Take with fluid. | |
| Gelnique 3%
(Actavis) |
gel | 28mg/pump | Children: not recommended.
Adults: Apply three pumps (84mg) once daily to dry, intact skin. Rotate application sites. |
Apply to abdomen, upper arms/shoulders, or thighs. Application should not be made to the same site on consecutive days. Avoid washing area/showering for 1 hour after application. | |
| Gelnique 10%
(Actavis) |
gel | 1g per sachet | Children: not recommended.
Adults: Apply one sachet once daily to dry, intact skin. Rotate application sites. |
||
| Solifenacin succinate | Vesicare
(Astellas) |
tabs | 5mg, 10mg | Children: not recommended.
Adults: Initially 5mg once daily; if well tolerated, may increase to 10mg once daily. Severe renal impairment (CrCl<30mL/min), moderate hepatic impairment, or concomitant potent CYP3A4 inhibitors (eg, ketoconazole): max 5mg once daily. |
Swallow whole with liquids. |
| Trospium chloride | Sanctura
(Allergan) |
tabs | 20mg | Children: not recommended.
Adults: 20mg twice daily. ≥75yrs: 20mg once daily if twice daily dose not tolerated. Severe renal impairment (CrCl<30mL/min): 20mg once daily at bedtime. |
Take on empty stomach. |
| Sanctura XR
(Allergan) |
ext-rel caps | 60mg | Children: not recommended.
Adults: 60mg daily in the AM. Severe renal impairment (CrCl<30mL/min): not recommended. |
Take on empty stomach. | |
| MUSCARINIC ANTAGONIST | |||||
| Fesoterodine fumarate | Toviaz
(Pfizer) |
ext-rel tabs | 4mg, 8mg | Children: not recommended.
Adults: 4mg once daily; max 8mg once daily. Severe renal insufficiency (CrCl<30mL/min) or concomitant potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, clarithromycin): max 4mg/day. |
Swallow whole. |
| Tolterodine tartrate | Detrol
(Pfizer) |
tabs | 1mg, 2mg | Children: not recommended.
Adults: 2mg twice daily; may decrease to 1mg twice daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 1mg twice daily. |
|
| Detrol LA
(Pfizer) |
ext-rel caps | 2mg, 4mg | Children: not recommended.
Adults: 4mg once daily; may decrease to 2mg once daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 2mg once daily. |
Swallow whole. | |
| NEUROMUSCULAR BLOCKER | |||||
| Onabotulinumtoxin A | Botox
(Allergan) |
vacuum-dried pwd; for intradetrusor inj after reconstitution and dilution | 50 Units/vial, 100 Units/vial, 200 Units/vial | <18yrs: not recommended.
Adults: See literature. Should be administered and managed by experienced physicians. Give prophylactic antibiotics 1–3 days pre-treatment, during, and 1–3 days post-treatment. Discontinue anti-platelet therapy at least 3 days before procedure. May premedicate with local or general anesthetic. Max total dose: 200 Units per treatment, as 1mL (~6.7 Units) injections across 30 sites into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. |
Observe at least 30mins post-injection. May consider re-treatment after effect of the previous injection diminishes but no sooner than 12 weeks. |
| VASOPRESSIN (SYNTHETIC) | |||||
| Desmopressin acetate | DDAVP
(sanofi aventis) |
scored tabs | 0.1mg, 0.2mg | <6yrs: not recommended.
6–17yrs: initially 0.2mg once daily at bedtime; individualize; max 0.6mg. |
|
| NOTES | |||||
|
caps = capsules; ext-rel = extended release; inj = injection; pwd = powder; tabs = tablets †Not an inclusive list. Please see drug monographs or visit www.eMPR.com (Rev. 4/2013) |
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