Overactive Bladder – Urinary Incontinence
OVERACTIVE BLADDER & URINARY INCONTINENCE TREATMENTS
Generic Brand Strength Form Dose
ANTICHOLINERGIC
imipramine HCl Tofranil 10mg, 25mg, 50mg tabs <6yrs: Not established. ≥6yrs: Childhood enuresis: Initially 25mg daily 1hr before bedtime; after 1wk, increase to 50mg for children 6−12yrs, up to 75mg if >12yrs. Early night bedwetters: Give 25mg in afternoon and repeat at bedtime. Max 2.5mg/kg/day.
ANTISPASMODIC/ANTICHOLINERGIC
oxybutynin chloride 5 mg scored tabs <5yrs: Not recommended. ≥5yrs: 5mg twice daily; max 15mg/day Adults: 5mg 2−3 times a day; max 20mg/day
5mg/  5mL syrup
Ditropan  XL 5mg, 10mg ext-rel tabs <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.
Gelnique  10% 1g/  sachet gel Children: Not established. Adults: Apply one sachet once daily to dry, intact skin. Rotate application sites.
oxybutynin transdermal system Oxytrol 3.9mg/  day patch Children: Not established. Adults: Apply 1 patch twice weekly (every 3−4 days) to clean, dry area on the abdomen, hip or buttock. Rotate application sites.
BETA-3 ADRENERGIC AGONIST
mirabegron Myrbetriq 25mg, 50mg ext-rel tabs Children: Not established. Adults: Initially 25mg once daily; may increase to 50mg once daily as needed or tolerated. Severe renal impairment or moderate hepatic impairment: max 25mg once daily.
vibegron Gemtesa 75mg tabs Children: Not established.
Adults: 75mg once daily.
MUSCARINIC ANTAGONIST
darifenacin HBr Enablex 7.5mg, 15mg ext-rel tabs Children: Not established. Adults: Initially 7.5mg once daily; may increase to 15mg once daily after 2wks. Moderate hepatic impairment (Child-Pugh B), concomitant potent CYP3A4 inhibitors: max 7.5mg once daily.
fesoterodine fumarate Toviaz 4mg, 8mg ext-rel tabs Children: Not established. Adults: 4mg once daily; may increase to max 8mg once daily. Severe renal impairment (CrCl <30mL/min) or concomitant potent CYP3A4 inhibitors: max 4mg/day.
solifenacin succinate Vesicare 5mg, 10mg tabs Children: Not established. 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.
Vesicare LS 1mg/mL oral susp Children: <2yrs: Not established.Take once daily, followed by liquid (eg, water or milk). ≥2yrs: 9–15kg: initially 2mL (max 4mL); >15–30kg: initially 3mL (max 5mL); >30–45kg: initially 3mL (max 6mL); >45–60kg: initially 4mL (max 8mL); >60kg: initially 5mL (max 10mL). Severe renal impairment (CrCl <30mL/min/1.73m2), moderate hepatic impairment (Child-Pugh B), or concomitant strong CYP3A4 inhibitors: do not exceed the recommended initial dose.
Adults: Use other form.
tolterodine tartrate Detrol 1mg, 2mg tabs Children: Not established. Adults: 2mg twice daily; may decrease to 1mg twice daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 1mg twice daily.
Detrol LA 2mg, 4mg ext-rel caps Children: Not established. Adults: 4mg once daily; may decrease to 2mg once daily. Concomitant CYP3A4 inhibitors, or significant renal or hepatic dysfunction: 2mg once daily.
trospium chloride 20mg tabs Children: Not established. 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.
60mg ext-rel caps Children: Not established. Adults: 60mg daily in the AM. Severe renal impairment (CrCl<30mL/min): not recommended.
NEUROMUSCULAR BLOCKER
onabotulinumtoxin A Botox 50 U/vial, 100 U/vial, 200 U/vial vacuum-dried pwd; for intradetrusor inj after reconstitution and dilution <18yrs: Not established. Adults: Overactive bladder: Max dose: 100 Units/treatment; give 20 injections of 0.5mL each into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. Detrusor overactivity: Max dose: 200 Units/treatment, give 30 injections of 1mL (~6.7 Units) each into the detrusor muscle via a flexible or rigid cystoscope, avoiding the trigone. Both: may consider re-treatment after effect of the previous injection diminishes but no sooner than 12wks. Max cumulative dose: 400 Units in a 3-month interval.
VASOPRESSIN (SYNTHETIC)
desmopressin acetate DDAVP 0.1mg, 0.2mg scored tabs <6yrs: Not recommended. ≥6yrs: Nocturnal enuresis: individualize. Initially 0.2mg once daily at bedtime; max 0.6mg.
Nocdurna 27.7mcg, 55.3mcg SL tabs Children: Not established. Adults: Give 1hr before bedtime. Dissolve under tongue. Nocturnal polyuria: 27.7mcg (females) or 55.3mcg (males) once daily.
NOTES

Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 6/2021)