Table 3

Pharmacologic treatment of urinary incontinence

DRUG CLASSUSED TO TREATGENERIC DRUG (TRADE NAME)INITIAL DOSE (USUAL DOSE)COMMENTS
AnticholinergicsUrge UIOxybutynin (Ditropan)
 
Oxybutynin XL (Ditropan XL)
 
Oxytrol patch
Tolterodine (Detrol)
Tolterodine LA (Detrol LA)
Darifenacin (Enablex)
 
Solifenacin (Vesicare)
 
Trospium (Trosec)		2.5 mg once daily at bedtime
(5 mg, 2–3 times daily)
5–10 mg once daily
(15–20 mg once daily)
36 mg every 3–4 d
1–2 mg twice daily
2–4 mg once daily
7.5 mg once daily (can increase at
2 wk to 15 mg once daily)
5 mg once daily
(can go to 10 mg once daily)
20 mg once daily at bedtime
(20 mg twice daily if eGFR > 30 mL/min)		SEs: dry mouth, blurred vision, constipation, confusion, GI discomfort
SEs are common in the elderly; sustained-release reported to have fewer SEs
EstrogenStress UIVaginal:

  • Premarin (0.625 mg/g cream)

  • Vagifem 25-μg (or 10–μg) vaginal tablet

  • Estring 2-mg vaginal tablet

Gel:

  • EstroGel 2.5 g daily

 

  • 0.5–2 g vaginally twice weekly

  • 1 tablet vaginally twice weekly

  • Ring vaginally every 90 d

Gel:

  • Apply as directed

The evidence for estrogen in stress UI is somewhat weak and controversial
AntidepressantsStress or mixed UITCA: imipramine10–25 mg at bedtime (50–100 mg/d)Avoid or use caution in the elderly
Moderate to severe stress UISNRI: duloxetine40–60 mg twice dailyLimited evidence in the elderly
α BlockersBPHAlfuzosin (Xatral)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Tamsulosin CR (Flomax CR)
Terazosin (Hytrin)		10 mg once daily after a meal
1–4 mg once daily at bedtime
0.4–0.8 mg once daily
0.4–0.8 mg once daily
1–5 mg once daily at bedtime		SEs: dizziness, postural hypotension

  • Reproduced from the RxFiles: Drug Comparison Charts16 with permission.

  • BPH—benign prostatic hypertrophy, CR—controlled release, eGFR—estimated glomerular filtration rate, GI—gastrointestinal, LA—long acting, SE—side effect, SNRI—serotonin noradrenergic reuptake inhibitor, TCA—tricyclic antidepressant, UI—urinary incontinence, XL—extended release.