NHS Bath and North East Somerset, Swindon and Wiltshire CCG Royal United Hospitals Bath NHS Foundation Trust Great Western Hospitals NHS Foundation Trust Salisbury NHS Foundation Trust
For use where anti-muscarinics have been ineffective or not tolerated or Mirabegron can be used FIRST line in high risk patients (those at risk of falls or have contra-indications to anti-muscarinics e.g.Elderly /Frail /Dementia/Parkinsons. See OAB guidance (below)
Contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg or diastolic blood pressure ≥110 mm Hg, or both).
COMBINATION USE OF MIRABEGRON PLUS SOLIFENACIN (AMBER TLS): This regimen is not licensed in the UK but might be recommended by a urology specialist after a patient has had urodynamics, with proven detrusor over-activity. Such use may be taken on by a GP if they are happy to take on the prescribing responsibility. See OAB guidance (below).
Specialist initiation for use in paediatrics or spinal/neurogenic bladder patients only.
HIGHLY ANTICHOLINERGIC; avoid in >65yrs and frail. Inform of risk of serious side effects incl. cognitive impairment (see PIL below). Stop if not effective.
Immediate release tablets 2.5mg, 3mg, 5mg - twice daily dosing. Side-effects may limit the use of immediate-release preparation.
Modified release tablets 5mg, 10mg.
Patch 36mg applied twice weekly. Restricted for those unable to take oral medicines.
Liquid 5mg/5ml Cost warning £235.53 per 150mL and oral solution 2.5mg/5ml £214.85 per 150mL (prices Oct 2020).
RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.
These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
Suitable for patient to be directed to buy themselves
Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.
Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.
