1. New drugs and the management of incontinence Stephen Mark

2. Drug therapy for incontinence zOAB: Anti cholinergics: different routes, Oxytrol and more selective [ M3], Tolteradine, Solifenacin, Darifenacin. Extended formula’s, Ditropan XL. Botox zSUI: Duloxetine

3. Normal bladder function Storage: Bladder Outlet Emptying: Bladder Outlet Abnormal bladder function Storage: High P [ OAB ] Treat: Bladder retraining Drugs Surgery

4. Affects men with BPH Combination medication alpha blocker and anticholinergic being trialled

5. Bladder retraining Effective Durable Minimum duration 2 months Better results with Continence therapist

6. Drug treatment: Aims Lower pressure of bladder and increase storage volume Reduce sensitivity bladder Minimal side effects Acceptable costs Drug utilisation is increasing

7. Drug treatment in OAB zOxybutinin: [ 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. zMost commonly used agent

8. New OAB Medication zEffectiveness zSide effects zCost zRole

9. Newer drugs for OAB Solifenacin Tolteradine

10. Ditropan XL zLonger acting Oxybutinin formula zRarely used in NZ zSimilar effectiveness but less side effects

11. Oxytrol: Oxybutinin patches zAvailable in NZ zSimilar effectiveness but less side effects zDose 2 patches per week zCost: $ 80 - $120 per month

12. Comparison oral vs transdermal Oxybutinin

13. Tolterodine [ Detrusitol] zM2 and M3 selective anticholinergic zstudied in adults and children zsimilar effectiveness to Oxybutinin zless side effects zbid dose 2 to 4 mg zCost: $ 80 - $ 120 per month

14. Comparison Oxybutinin and Tolteradine

15. Solifenacin [ Vesicare] zM3 selective anticholinergic zstudied in adults zsimilar effectiveness to Oxybutinin zless side effects zonce daily dose 5 or 10 mg zCost: $ 80 - $120 per month

16. Cost of medication z$ 80 - $120 per month zdependant on pharmacy and location zoccasional company discount

17. Darifenacin [Enablex] zM3 antagonist znot available in NZ zbid dose

18. Comparison M3 receptor antagonists

19. 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

20. Duloxotine for SUI zSerotonin NE uptake inhibitor zanti depressant z10 RCT showing 50% effective in reducing SUI….. Not curative zImproved Qol zSignificant side effects [ 20% withdrawl] zSummary: No role in SUI treatment

21. The End