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MEDICATIONS FOR STRESS INCONTINENCE

There are currently no medications that are approved by the FDA (Food and Drug Administration) for the treatment of stress incontinence (SUI), but several promising studies are being conducted on new medications that may be useful in managing SUI. These medications appear to act on the neurochemicals that influence urethral pressure. When pressure in the urethra is maintained, there is less likelihood of leakage.

MEDICATIONS FOR URGE INCONTINENCE

Urge incontinence and overactive bladder result from involuntary bladder contractions. Certain medications called anticholinergic/antimuscarinics can block the chemicals that act on the bladder nerves and decrease unwanted bladder contractions. Many of these drugs are safe for long term use, though people who have glaucoma should check with the ophthalmologist before starting anticholinergic/antimuscarinic medication. It is also important to tell your health care provider what other medications you are taking to avoid potential problems with new medications.

Anticholinergic/antimuscarinic medications can have side effects. The most common side effect is dry mouth, which can range from mild to severe. Constipation and dry eyes are less common side effects. More rarely, drowsiness, confusion or heart palpitations occur in people taking these medicines. Your health care provider will work closely with you to determine the correct type and dosage of medication to balance improved bladder control and bothersome side effects.

Several new medications have been developed for the treatment of OAB, but there is no one medication that is right for everyone. Depending on the specific medication ordered, they may need to be taken once or several times a day to maintain effect. Choosing the right medication for you should be done in consultation with your health care provider. Every effort is made to balance the positive effect of the medication with the potential side effects. Medications can vary in price and effectiveness. You may be asked to try a new medication for up to one month before determining whether it is providing the correct balance of relief of symptoms and minimal side effects.

Here is a list of some of the medications used for urge incontinence/ overactive bladder (table updated on 10/15/09):

Brand Name Generic How Taken
Ditropan Oxybutynin (short acting) 5mg tablets, ½-1 tablet 2 – 4 times a day
Ditropan XL, Oxybutynin ER Oxybutynin (long acting) 5-15mg tablets, 1-2 tablets once a day
Oxytrol Oxybutynin transdermal patch 3.9mg patch changed every 3-4 days
Gelnique oxybutinin gel 100 mg/g about 1mL applied to skin daily
Detrol Tolterodine (short acting) 1-2mg tablets, twice a day
Detrol LA Tolterodine (long acting) 2-4mg capsules, once a day
Tofranil, Tofranil PM Imipramine 10-75mg
Levsin, Levbid Hyoscyamine 0.125-375mg twice a day
Enablex Darifenacin 7.5-15mg tablets, once a day
Sanctura Trospium chloride 20mg tablets, twice a day on an empty stomach
Sanctura XR Trospium chloride (long acting) 60mg  -  1 tablet daily in AM on empty stomach
VESIcare Solifenacin succinate 5mg or 10mg, 1 tablet daily
Toviaz fesoteradine fumarate 4-8mg tablets daily

Strategies for managing common side effects of medications:

Side Effect Remedy
Dry Eyes Artificial Tears, Preservative free moisturizing eye drops
Dry Mouth Lozenges, hard candy,chewing gum, Biotene or other dry mouth products (don’t increase water consumption unless not drinking enough – this varies from person to person)
Constipation Bran/increase fresh vegetables and/or fruit, exercise, Metamucil/Citrucel/Benefiber or other fiber supplement, stool softener (colace), drink enough water
Nausea Ginger root tea or ginger capsules, Mint tea, exercise, Tums

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coe@obgyn.ucsf.edu. Last updated: 10/14/2009

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