pharmaceuticals used to treat urinary incontinence

Management: Stress urinary incontinence: 1) alpha adrenergic receptor agonists a) increase of smooth muscle tone at bladder outlet b) phenylpropanolamine (Dimetapp) 25-50 mg every 6-8 hours c) pseudoephedrine (Sudafed) 30-60 mg every 6-8 hours 2) tricyclic antidepressants (TCA) a) decrease in detrusor muscle contractility & increase in bladder outlet resistance b) imipramine (Tofranil) 25-100 mg QHS c) doxepine (Sinequan) 25-100 mg QHS 3) estrogen a) vaginal cream (Premarin): 1-2 gm QHS for 1-2 weeks, then 1 g 1-3 times per week b) premarin 0.625 mg PO QD (+/-) Provera 2.5 mg QD Urge incontinence: 1) anticholinergic agents a) inhibition of involuntary detrusor contractions b) propantheline (Pro-Banthine) 15 mg QID c) imipramine (Tofranil) 25-100 mg QHS d) hyocyamine (Levsinex) 0.375 mg BID 2) smooth muscle relaxants a) oxybutynin (Ditropan) 2.5-5 mg BID/TID b) flavoxate (Urispas) 100-200 mg TID-QID c) dicyclomine (Bentyl) 20 mg QID d) tolterodine (Detrol) 1-2 mg PO BID 3) calcium channel antagonists a) inhibit bladder contractions b) nifedipine (Procardia) 10 mg TID c) efficacy not proven d) may be useful for patient with hypertension or cardiac arrhythmia 4) estrogen replacement therapy a) alleviates sensory problems in postmenopausal women - urgency, frequency, dysuria, nocturia Overflow incontinence: 1) alpha-adrenergic receptor antagonists a) reduce sphincter resistance b) prazosin (Minipress) 1-5 mg TID c) terazosin (Hytrin) 1-5 mg QHS d) doxazosin (Cardura) 1-4 mg QHS 2) cholinergic agents a) improve detrusor muscle contractility b) bethanechol (Urecholine) 10-50 mg TID/QID 3) anti-androgen therapy a) regression of hyperplastic prostate tissue b) 2-6 months may be required before improvement of symptoms c) finasteride (Proscar) 5 mg QID