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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 

 Details...
07.04.02  Expand sub section  Drugs for urinary frequency, enuresis, and incontinence
 note 

BSW Guidelines for the Pharmacological Management of Overactive Bladder Disease in Adults in Primary Care (Updated October 2020)

Anticholinergic Medicines (information leaflet for patients) Print version

Anticholinergic Medicines (information leaflet for patients) On-line version

07.04.02  Expand sub section  Urinary incontinence
Solifenacin
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First Choice
traffic lightGreen
  • Tablets 5mg, 10mg

 

 
Tolterodine
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Second Choice
traffic lightGreen
  • Immediate release tablets 1mg, 2mg.
  • Modified release capsules 2mg, 4mg (once daily dosing to improve  compliance). MR formulation is not suitable for hepatic or renal impairment. 
 
Link  Anticholinergic medicines (information leaflet for patients)
 
Trospium
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Second Choice
traffic lightGreen
  • 20mg tablet
 
Link  Anticholinergic medicines (information leaflet for patients)
 
Mirabegron
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Third Choice
traffic lightGreen
  • Tablets MR 25mg, 50mg 
  • 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).

 
Link  BSW Guidelines for Management of Overactive Bladder Disease in Adults in Primary Care
Link  MHRA DSU Oct 2015: Mirabegron (Betmiga„): risk of severe hypertension and associated cerebrovascular and cardiac events
Link  NICE TA290: Mirabegron for overactive bladder
 
Oxybutynin
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Formulary
traffic lightAmber
  • 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)
 
Link  Anticholinergic medications (information leaflet for patients)
 
 ....
 Non Formulary Items
Darifenacin (Emselex®)

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Non Formulary
 
Duloxetine (Yentreve®)

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Non Formulary
 
Fesoterodine (Toviaz®)

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Non Formulary
 
Flavoxate (Urispas 200®)

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Non Formulary
 
Oxybutynin Intra-vesical
(5mg/30ml)

View adult BNF View SPC online
Non Formulary
 
Propantheline

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Non Formulary

Not included on BSWformulary for adult enuresis

 
Propiverine

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

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.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(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.   

Traffic LightRed Specialist Centre

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.  

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