New drugs and the management of incontinence Stephen Mark.
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Transcript of 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
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
Ditropan XL
Longer acting Oxybutinin formulaRarely used in NZSimilar effectiveness but less side
effects
Oxytrol: Oxybutinin patches
Available in NZSimilar effectiveness but less side
effectsDose 2 patches per weekCost: $ 80 - $120 per month
Tolterodine [ Detrusitol]
M2 and M3 selective anticholinergicstudied in adults and childrensimilar effectiveness to Oxybutininless side effectsbid dose 2 to 4 mgCost: $ 80 - $ 120 per month
Solifenacin [ Vesicare]
M3 selective anticholinergicstudied in adultssimilar effectiveness to Oxybutininless side effectsonce daily dose 5 or 10 mgCost: $ 80 - $120 per month
Cost of medication
$ 80 - $120 per monthdependant on pharmacy and locationoccasional company discount
Role of anticholinergics in NZ
Oxybutinin fully fundedAll other drugs equal and similar efficacyAll 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 effectsPatient will need to pay
Duloxotine for SUI
Serotonin NE uptake inhibitoranti depressant10 RCT showing 50% effective in
reducing SUI….. Not curativeImproved QolSignificant side effects [ 20%
withdrawl]Summary: No role in SUI treatment