New OAB Drugs
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Transcript New OAB Drugs
New drugs and the
management of
incontinence
Stephen Mark
Drug therapy for incontinence
OAB: Anti cholinergics: different routes,
Oxytrol and more selective [ M3],
Tolteradine, Solifenacin, Darifenacin.
Extended formula’s, Ditropan XL . Botox
SUI: Duloxetine
Normal bladder function
Storage:
Bladder
Outlet
Emptying: Bladder
Outlet
Abnormal bladder
function
Storage: High P [ OAB ]
Treat: Bladder retraining
Drugs
Surgery
Affects men with BPH
Combination medication alpha
blocker and anticholinergic
being trialled
Bladder retraining
Effective
Durable
Minimum duration 2 months
Better results with Continence
therapist
Drug treatment: Aims
Lower pressure of bladder and
increase storage volume
Reduce sensitivity bladder
Minimal side effects
Acceptable costs
Drug utilisation is increasing
Drug treatment in OAB
Oxybutinin: [ Ditropan ]: Anticholinergic.
Direct smooth muscle relaxant [ M1,2,3] and local
anaesthetic. Non-selective agent. 70% effective but over
50% stop due to intolerable side effects [ dry mouth,
blurred vision, GI symptoms…]. Government funded .
Most commonly used agent
New OAB Medication
Effectiveness
Side effects
Cost
Role
Newer drugs for OAB
Solifenacin
Tolteradine
Ditropan XL
Longer acting Oxybutinin formula
Rarely used in NZ
Similar effectiveness but less side effects
Oxytrol: Oxybutinin
patches
Available in NZ
Similar effectiveness but less side effects
Dose 2 patches per week
Cost: $ 80 - $120 per month
Comparison oral vs transdermal
Oxybutinin
Tolterodine [ Detrusitol]
M2 and M3 selective anticholinergic
studied in adults and children
similar effectiveness to Oxybutinin
less side effects
bid dose 2 to 4 mg
Cost: $ 80 - $ 120 per month
Comparison
Oxybutinin and
Tolteradine
Solifenacin [ Vesicare]
M3 selective anticholinergic
studied in adults
similar effectiveness to Oxybutinin
less side effects
once daily dose 5 or 10 mg
Cost: $ 80 - $120 per month
Cost of medication
$ 80 - $120 per month
dependant on pharmacy and location
occasional company discount
Darifenacin [Enablex]
M3 antagonist
not available in NZ
bid dose
Comparison M3 receptor
antagonists
Role of anticholinergics in NZ
Oxybutinin fully funded
All other drugs equal and similar efficacy
All other drugs less side effects
Pharmac unlikely to change
Dose escalation Oxybutinin to reduce side effects
[ except children]
Offer alternative if effective and significant side effects
Patient will need to pay
Duloxotine for SUI
Serotonin NE uptake inhibitor
anti depressant
10 RCT showing 50% effective in
reducing SUI….. Not curative
Improved Qol
Significant side effects [ 20% withdrawl]
Summary: No role in SUI treatment
The End