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7.1 Bladder and urinary disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

7.1.1 Urinary frequency, enuresis, and incontinence

 

National guidelines

 

 

 

 

 

 

Local guidelines

 

 

 

 

Drug Treatment

  • Desmopressin is licensed for nocturnal enuresis.    
  • Tricyclic antidepressants may also be used to treat nocturnal enuresis.
  • Do not use flavoxate, propantheline and imipramine for the treatment of UI or OAB in women.
  • Do not offer oxybutynin (immediate release) to frail older women.
  • Offer one of the following choices first to women with OAB or mixed UI:
    • oxybutynin (immediate release), or
    • tolterodine (immediate release), or
    • darifenacin (once daily preparation).
  • If the first treatment for OAB or mixed UI is not effective or well-tolerated, offer another drug with the lowest acquisition cost.
  • Offer a transdermal OAB drug to women unable to tolerate oral medication.

 

 

 

Oxybutynin

  • Tablets 2.5mg, 3mg, 5mg

Notes:

  • Oxybutynin standard release is the first choice drug therapy. Patients may experience anticholinergic side effects. Therefore the minimum effective dose should be used. 
  • However, many patients referred to secondary care on low doses respond well to higher doses so GPs should consider increasing the dose of oxybutynin to 5mg TDS before referral.      

 

Tolterodine

  • Tablets 1mg, 2mg
  • Capsules 4mg modified release

 

Darifenacin (Amber 2)

  • Tablets modified release 7.5mg, 15mg      

 

Trospium (Amber 2)

  • Tablets 20mg      

 

Mirabegron (Amber 3)

  • Tablets modified release 25mg, 50mg

Notes:

 

 

 

7.1.2 Urinary retention   

 

Doxazosin

  •      Tablet 1mg, 2mg, 4mg

 

Prazosin

  • Tablet 500micrograms, 1mg, 2mg

 

Tamsulosin hydrochloride

  • Modified release capsules 400 micrograms

Notes:

  • Unlicensed use: Approved for treatment of ureteric colic

 

Finasteride (Amber 1)

  • Tablet 5mg

 Notes:

 

 

 

7.1.3 Urological pain

 

Alkalinising drugs

 

Potassium citrate

  • Efferescent tablets 1.5g 

Notes:

  • The discomfort of cystitis may be relieved by alkalinisation of urine with potassium citrate.  

 

Sodium bicarbonate BP

  • Powder

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

Return to Chapter: 7. Obstetrics, Gynaecology and Urinary-tract Disorders

Last updated by: Sheila Wood on 23-04-2019 10:23