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Incontinence - urinary, in women - Management
What dose of antimuscarinic should I prescribe?
- Antimuscarinic adverse effects can limit treatment success. Adverse effects can be reduced by starting at a low dose and gradually increasing until a satisfactory clinical response is achieved.
- For oxybutynin [ABPI Medicines Compendium, 2007a; ABPI Medicines Compendium, 2007c]:
- The usual starting dose is 5 mg two or three times a day.
- In elderly women, a starting dose of 2.5 mg or 3 mg twice daily is recommended by the manufacturers of oxybutynin.
- Increase the dose as necessary to a maximum of 5 mg four times a day.
- Modified-release preparations are effective and have fewer adverse effects than immediate-release preparations, but they are more expensive.
- Other antimuscarinic drugs should also be prescribed cautiously in frail and elderly people because of an increased risk of adverse effects. For further information, see Management of urgency incontinence symptoms/ overactive bladder.
- For dosage information, see Table 1.
Clarification / Additional information
- Dosages for the various antimuscarinic preparations are listed in Table 1.
Table 1. Licensed doses of antimuscarinics drugs for incontinence.
Antimuscarinic preparations | Dose |
|---|
Oxybutynin immediate-release tablets (2.5 mg, 3 mg and 5 mg) | 5 mg two or three times a day, increasing to a maximum of 5 mg four times a day. In elderly women, a starting dose of 2.5 mg or 3 mg twice a day is recommended. |
Oxybutynin modified-release tablets (5 mg and 10 mg) (Lyrinel XL®) | 5 mg daily, increasing to 10 mg daily after 7 days if necessary. Total daily dose should not exceed 20 mg. There should be an interval of at least one week between any increase or decrease in dose. |
Oxybutynin transdermal patch (releasing 3.9 mg of oxybutynin per 24 hours) (Kentera®) | One 3.9 mg transdermal patch applied twice weekly (every 3 to 4 days).
|
Darifenacin modified-release tablets (7.5 mg and 15 mg) (Emselex®) | 7.5 mg daily, increasing to 15 mg daily after 2 weeks if necessary.
For people with moderate hepatic impairment (Child–Pugh score 7–9): the dose should be restricted to 7.5 mg daily.
|
Fesoterodine modified-release tablets (4 mg and 8 mg) (Toviaz®) | 4 mg daily, increasing to 8 mg daily if necessary.
Full treatment effect was observed between 2 and 8 weeks.
|
Solifenacin immediate-release tablets (5 mg and 10 mg) (Vesicare®) | 5 mg daily, increasing to 10 mg daily if necessary.
For people with severe renal impairment (creatinine clearance 30 mL/min or less), moderate hepatic impairment (Child–Pugh score of 7–9), and if treated with a potent inhibitors of cytochrome CYP 3A4 (such as ketoconazole, itraconazole, nelfinavir, and ritonavir): do not exceed 5 mg daily.
|
Tolterodine immediate-release tablets (1 mg and 2 mg) (Detrusitol®) | 2 mg twice a day. Reduce to 1 mg twice a day if adverse effects are troublesome.
For people with impaired liver function or severe renal impairment (GFR 30 mL/min or less): 1 mg twice a day.
|
Tolterodine modified-release tablets (4 mg) (Detrusitol XL®) | 4 mg daily.
This formulation is not suitable for people with impaired liver function or severe renal impairment (GFR 30 mL/min or less). |
Trospium immediate-release tablets (20 mg) (Regurin®) | 20 mg twice a day (on a empty stomach).
For people with severe renal impairment (creatinine clearance 10–30 mL/min/1.73 m2): 20 mg daily or every second day.
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