pharmaceuticals used to treat urinary incontinence

Management

Stress urinary incontinence:

• alpha adrenergic receptor agonists
  • increase of smooth muscle tone at bladder outlet
  • phenylpropanolamine (Dimetapp) 25-50 mg every 6-8 hours
  • pseudoephedrine (Sudafed) 30-60 mg every 6-8 hours
• tricyclic antidepressants (TCA)
  • decrease in detrusor muscle contractility & increase in bladder outlet resistance
  • imipramine (Tofranil) 25-100 mg QHS
  • doxepine (Sinequan) 25-100 mg QHS
• estrogen
  • vaginal cream (Premarin): 1-2 gm QHS for 1-2 weeks, then 1 g 1-3 times per week
  • premarin 0.625 mg PO QD (+/-) Provera 2.5 mg QD

Urge incontinence:

• anticholinergic agents
  • inhibition of involuntary detrusor contractions
  • propantheline (Pro-Banthine) 15 mg QID
  • imipramine (Tofranil) 25-100 mg QHS
  • hyocyamine (Levsinex) 0.375 mg BID
• smooth muscle relaxants
  • oxybutynin (Ditropan) 2.5-5 mg BID/TID
  • flavoxate (Urispas) 100-200 mg TID-QID
  • dicyclomine (Bentyl) 20 mg QID
  • tolterodine (Detrol) 1-2 mg PO BID
• calcium channel antagonists
  • inhibit bladder contractions
  • nifedipine (Procardia) 10 mg TID
  • efficacy not proven
  • may be useful for patient with hypertension or cardiac arrhythmia
• estrogen replacement therapy
  • alleviates sensory problems in postmenopausal women
    • urgency, frequency, dysuria, nocturia

Overflow incontinence:

• alpha-adrenergic receptor antagonists
  • reduce sphincter resistance
  • prazosin (Minipress) 1-5 mg TID
  • terazosin (Hytrin) 1-5 mg QHS
  • doxazosin (Cardura) 1-4 mg QHS
• cholinergic agents
  • improve detrusor muscle contractility
  • bethanechol (Urecholine) 10-50 mg TID/QID
• anti-androgen therapy
  • regression of hyperplastic prostate tissue
  • 2-6 months may be required before improvement of symptoms
  • finasteride (Proscar) 5 mg QID