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BNSSG Adult Joint Formulary

7.1 Bladder and urinary disorders

Last edited: 15-04-2024

7.1.1 Urinary frequency, enuresis, and incontinence

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Antimuscarinics

Tolterodine standard-release (TLS Green)

Alternatives:

Tolterodine modified-release (TLS Blue)

  • For patients in whom compliance is an issue

Trospium standard-release (TLS Blue)

  • For patients unable to tolerate oral Tolterodine

Oxybutynin modified and standard-release (TLS Blue)

  • For Neurosciences patients 

Trospium modified-release (TLS Blue)

  • For patients unable to tolerate oral Tolterodine or oxybutynin 

Solifenacin (TLS Blue)

  • For patients unable to tolerate Tolterodine or oxybutynin

Oxybutynin (transdermal) (TLS Blue)

  • For patients only who gained benefit from oral oxybutynin but experienced intolerable side-effects

 

Other

Duloxetine (TLS Amber Specialist Recommended)

  • For moderate to severe stress urinary incontinence in women only

Desmopressin (Noqdirna®) (TLS Amber 3 months)

  • For the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults, see SCP here

 

Beta3-Adrenoceptor agonists

Mirabegron (TLS Blue)

  • NICE TA290 For use in patients after bladder training and two other antimuscarinics are contraindicated or clinically ineffective
  • Note: Combination therapy of Solifenacin and Mirabegron are recognised as a treatment option for the treatment of OAB.

Other

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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