netFormulary

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.

Solifenacin

First Choice

5mg and 10mg tablets

Tolterodine 1mg and 2mg tablets

First Choice

Darifenacin

Formulary

MR Tablets - 7.5mg, 15mg

Duloxetine

Formulary

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

Fesoterodine

Formulary

MR Tablets - 4mg, 8mg

Propiverine

Formulary

Tablets: 15mg

Trospium

Formulary

Tablets: 20mg

Mirabegron

Formulary

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

NICE TA290: Mirabegron for overactive bladder

MHRA Drug Safety Update (Oct 2015): Mirabegron�-�risk�of severe�hypertension�and�associated�cerebrovascular�and�cardiac events

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.

Vibegron Obgemsa^®

Formulary

75mg film-coated tablets
- Approved for treating symptoms of overactive bladder syndrome in adults in line with NICE

NICE TA999: Vibegron for treating symptoms of overactive bladder syndrome

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.

MHRA Drug Safety Update (Sep 2022): Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations

North of Tyne, Gateshead and North Cumbria: Giggle Incontinence in children & young people aged 8 to 18 years

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

NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management

NTAG: Vaginal devices for female urinary stress incontinence