North East and North Cumbria
ICS Formulary
 
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7 Obstetrics, Gynaecology, and urinary-tract disorders
07-04-02 Urinary incontinence

Oxybutynin
First Choice
  • 2.5mg and 5mg tablets
  • 2.5mg in 5ml & 1mg/1ml oral solution
  • Immediate release oxybutinin is not appropriate for frail elderly people or those with cognitive impairment.

 


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Solifenacin
First Choice

  • 5mg and 10mg tablets 


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Tolterodine 1mg and 2mg tablets
First Choice

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Darifenacin
Formulary
  • MR Tablets - 7.5mg, 15mg

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Duloxetine
Formulary
  • Capsules: 20mg, 40mg
  • Moderate to severe stress incontinence in combination with supervised pelvic floor excercises only

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Fesoterodine
Formulary
  •  MR Tablets - 4mg, 8mg

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Propiverine
Formulary
  • Tablets: 15mg

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Trospium
Formulary
  • Tablets: 20mg

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Mirabegron
Formulary

  • Approved for use when antimuscarinics don’t work, are not suitable or side effects are unacceptable, in line with NICE guidance. 

Link  NICE TA290: Mirabegron for overactive bladder
Link  MHRA Drug Safety Update (Oct 2015): Mirabegron - risk of severe hypertension and associated cerebrovascular and cardiac events

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Oxybutynin Hydrochloride - patch
Formulary
  • Oxybutinin patch 36mg (releases approximately 3.6mg in 24 hours). 
  • Approved for patients in whom two antimuscarinics have proved to be efficacious but the side effects are intolerable, or for patients who cannot swallow tablets.



 


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Methylphenidate
Formulary
  • Methylphenidate is approved for use as a third line option (after e.g. antimuscarinics, imipramine, and pelvic floor exercises) in the treatment of giggle incontinence in children. Its use should be subject to a therapeutic trial to be reviewed after two months and considered for Shared Care if patients have been shown to respond after the trial period.
  • The following methylphenidate formulations are approved for giggle incontinence:
    • 5mg & 10mg tablets.
    • 10mg, 20mg & 30mg m/r capsules (Equasym XL®).
    • 18mg, 27mg & 36mg m/r tablets (Xaggitin® XL)
  • Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
  • Xaggitin® XL is bioequivalent to Concerta® XL
  • The effects of Equasym® XL last for about 8 hours compared with about 12 hours for Xaggitin® XL. 
Link  MHRA Drug Safety Update (Sep 2022): Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
Link  North of Tyne, Gateshead and North Cumbria: Giggle Incontinence in children & young people aged 8 to 18 years

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Vaginal Devices
Formulary
  • Vaginal Devices for female stress urinary incontinence (e.g. Diveen, Contiform, Efemia)
  • Approved for use in line with NTAG / NICE
  • Product should only be initiated by a specialist pelvic health physiotherapists and specialist nurses
Link  NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management
Link  NTAG: Vaginal devices for female urinary stress incontinence

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