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New drugs and the management of incontinence

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

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New drugs and the management of incontinence

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  1. New drugs and the management of incontinence Stephen Mark

  2. 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

  3. Normal bladder function Storage: Bladder Outlet Emptying: Bladder Outlet Abnormal bladder function Storage: High P [ OAB ] Treat: Bladder retraining Drugs Surgery

  4. Affects men with BPH Combination medication alpha blocker and anticholinergic being trialled

  5. Bladder retraining Effective Durable Minimum duration 2 months Better results with Continence therapist

  6. Drug treatment: Aims Lower pressure of bladder and increase storage volume Reduce sensitivity bladder Minimal side effects Acceptable costs Drug utilisation is increasing

  7. 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

  8. New OAB Medication • Effectiveness • Side effects • Cost • Role

  9. Newer drugs for OAB Solifenacin Tolteradine

  10. Ditropan XL • Longer acting Oxybutinin formula • Rarely used in NZ • Similar effectiveness but less side effects

  11. Oxytrol: Oxybutinin patches • Available in NZ • Similar effectiveness but less side effects • Dose 2 patches per week • Cost: $ 80 - $120 per month

  12. Comparison oral vs transdermal Oxybutinin

  13. 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

  14. Comparison Oxybutinin and Tolteradine

  15. 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

  16. Cost of medication • $ 80 - $120 per month • dependant on pharmacy and location • occasional company discount

  17. Darifenacin [Enablex] • M3 antagonist • not available in NZ • bid dose

  18. Comparison M3 receptor antagonists

  19. 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

  20. 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

  21. The End

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