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BNSSG Adult Joint Formulary

7.1 Bladder and urinary disorders

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Last edited: 25-07-2024

7.1.1 Urinary frequency, enuresis, and incontinence

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Antimuscarinics

Solifenacin (TLS Green)

Trospium standard-release (TLS Blue)

Locally preferred next option for patients who are unable to tolerate solifenacin

Trospium modified-release (TLS Blue)

For patients where trospium is effective but compliance issues with twice daily dosage of standard release trospium.

Tolterodine standard-release (TLS Blue)

Oxybutynin standard-release (TLS Blue)

For Neurosciences patients. Avoid in frail or elderly patients due to high anticholinergic burden.

Oxybutynin modified release (TLS Blue)

For Neurosciences patients where compliance with twice daily or four times daily dosage of standard release oxybutynin is an issue. Avoid in frail or elderly patients due to high anticholinergic burden.

Oxybutynin (transdermal) (TLS Blue)

For patients unable to swallow oral formulations. Avoid in frail or elderly patients due to high anticholinergic burden.

Beta₃-Adrenoceptor agonists

Mirabegron (TLS Blue)

For use in patients after bladder training and where antimuscarinics are contraindicated/patient/clinician does not want to trial antimuscarinics due to anticholinergic burden; or where one antimuscarinic has been tried at maximum recommended dose and proved ineffective or where two antimuscarinics have been tried at suboptimal dose but not tolerated due to adverse effects.
NICE TA290
Contraindicated in severe, uncontrolled hypertension and/or eGFR <30mL/minute.
Note: Combination therapy of Solifenacin and Mirabegron are recognised as a treatment option for the treatment of OAB.

Other

Duloxetine (TLS Amber Specialist Recommended)

For moderate to severe stress urinary incontinence in women only

Desmopressin (Noqdirna^®) (TLS Amber Specialist Recommended)

For the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults

Botulinum toxin type A (TLS Red)

For use in urinary incontinence due to overactive bladder and neurogenic detrusor overactivity where oral antimuscarinic treatments have failed

See Botulinum Toxin A Pathway page for more information

7.1.2 Urinary retention

Alpha-Adrenoceptor blockers

Benign Prostatic Hyperplasia (BPH) is treated either surgically or medically with alpha-blockers or with the anti-androgen finasteride

Doxazosin standard-release (TLS Green)

Tamsulosin capsules modified-release (TLS Green)

Alternative: (TLS Blue)

Alfuzosin modified-release

Main formulary use is for ejaculatory dysfunction caused by tamsulosin

5-Alpha-reductase Inhibitors

Finasteride (TLS Green)

Specific indication:

Dutasteride (TLS Blue)

For patients who are intolerant of finasteride. Alone or in combination with Tamsulosin

7.1.3 Urological pain

Alkalinising Drugs

Potassium citrate BP (TLS Green)

Sodium bicarbonate (TLS Green)

Specific Indication: (TLS Red)

Urocit K^®

For the use by renal teams only, for the treatment of distal renal tubular acidosis, and the treatment of Hypocitraturia when patients are unable to tolerate Potassium citrate BP

Pentosan polysulfate sodium

For the use of treating bladder pain syndrome as per NICE TA610

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