Urinary Incontinence

Question 1

What medications are used for urinary incontinence?

Answer 1

Anticholinergics mainly used for urge/overactive bladder
*Tolteridone (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare), darafenacin (Enablex) - antagonist at muscarinic receptors preventing action of acetylcholine, resulting in relaxation of bladder smooth muscle with can reduce urge, spasm and frequency.
*Oxybutynin comes in patch form which can cause more systemic anticholinergics effects
*Trospium less likely to cross blood brain barrier, potentially best with pre-existing dementia or cog impairment

Beta-agonist: Mirabegron (Myrbetric), Vibegron (Gemtasa)
*has some selectivity for bladder but systemic effects still possible — may increase blood pressure
*possible 2D6 interactions, vibegron avoids 2D6

Botox
Topical estrogen
Duloxetine: off-label indication for stress incontinence