New drugs and the management of incontinence Stephen Mark
Drug therapy for incontinence zOAB: Anti cholinergics: different routes, Oxytrol and more selective [ M3], Tolteradine, Solifenacin, Darifenacin. Extended formula’s, Ditropan XL. Botox zSUI: Duloxetine
Normal bladder function Storage: Bladder Outlet Emptying: Bladder Outlet Abnormal bladder function Storage: High P [ OAB ] Treat: Bladder retraining Drugs Surgery
Affects men with BPH Combination medication alpha blocker and anticholinergic being trialled
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 zOxybutinin: [ 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. zMost commonly used agent
New OAB Medication zEffectiveness zSide effects zCost zRole
Newer drugs for OAB Solifenacin Tolteradine
Ditropan XL zLonger acting Oxybutinin formula zRarely used in NZ zSimilar effectiveness but less side effects
Oxytrol: Oxybutinin patches zAvailable in NZ zSimilar effectiveness but less side effects zDose 2 patches per week zCost: $ 80 - $120 per month
Comparison oral vs transdermal Oxybutinin
Tolterodine [ Detrusitol] zM2 and M3 selective anticholinergic zstudied in adults and children zsimilar effectiveness to Oxybutinin zless side effects zbid dose 2 to 4 mg zCost: $ 80 - $ 120 per month
Comparison Oxybutinin and Tolteradine
Solifenacin [ Vesicare] zM3 selective anticholinergic zstudied in adults zsimilar effectiveness to Oxybutinin zless side effects zonce daily dose 5 or 10 mg zCost: $ 80 - $120 per month
Cost of medication z$ 80 - $120 per month zdependant on pharmacy and location zoccasional company discount
Darifenacin [Enablex] zM3 antagonist znot available in NZ zbid dose
Comparison M3 receptor antagonists
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
Duloxotine for SUI zSerotonin NE uptake inhibitor zanti depressant z10 RCT showing 50% effective in reducing SUI….. Not curative zImproved Qol zSignificant side effects [ 20% withdrawl] zSummary: No role in SUI treatment
The End