Medications Used to Treat Incontinence
Medications | Mechanisms | Comments |
|---|---|---|
Outlet Bladder incompetence in stress incontinence | ||
DuloxetineDuloxetine | Centrally acting serotonin and norepinephrine reuptake inhibitionCentrally acting serotonin and norepinephrine reuptake inhibition | Duloxetine increases urinary sphincter striated muscle tone.Duloxetine increases urinary sphincter striated muscle tone. It appears to be effective, but experience with it is limited. |
ImipramineImipramine | Tricyclic antidepressant, anticholinergic, and alpha-agonist effects | Imipramine is useful for nocturia and mixed incontinence caused by detrusor overactivity and bladder outlet incompetence. Imipramine is useful for nocturia and mixed incontinence caused by detrusor overactivity and bladder outlet incompetence. Acceptable as temporary adjunctive therapy to reduce enuresis in children aged ≥ 6 years. |
PseudoephedrinePseudoephedrine | Alpha-agonist effects | Pseudoephedrine stimulates urethral smooth muscle contraction.Pseudoephedrine stimulates urethral smooth muscle contraction. Adverse effects include insomnia, anxiety, and, in men, urinary retention. This drug is not recommended for people with heart disorders, hypertension, glaucoma, diabetes, hyperthyroidism, or benign prostatic hyperplasia. |
Bladder outlet obstruction in men with urge or overflow incontinence | ||
AlfuzosinAlfuzosin | Alpha-adrenergic blockade | In men, alpha-adrenergic blockers relieve symptoms of outlet obstruction, may reduce postvoid residual volume and outlet resistance, and may increase urinary flow rate. Effect occurs within days to weeks. Adverse effects include hypotension, fatigue, asthenia, and dizziness. |
DoxazosinDoxazosin | ||
PrazosinPrazosin | ||
SilodosinSilodosin | ||
TamsulosinTamsulosin | ||
TerazosinTerazosin | ||
DutasterideDutasteride | 5-Alpha-reductase inhibition | Dutasteride and finasteride reduce prostate size and obstructive symptoms and make transurethral resection of prostate glands > 50 g less likely to be needed.Dutasteride and finasteride reduce prostate size and obstructive symptoms and make transurethral resection of prostate glands > 50 g less likely to be needed. Adverse effects are minimal and consist of sexual dysfunction (eg, decreased libido, erectile dysfunction). |
FinasterideFinasteride | ||
TadalafilTadalafil | Not established | Tadalafil is also used to treat Tadalafil is also used to treaterectile dysfunction. If possible, it should not be used in patients taking nitrates or alpha-adrenergic blockers. |
Detrusor overactivity in urge or stress incontinence* | ||
DarifenacinDarifenacin | Anticholinergic effects, selective M3 muscarinic antagonism | Adverse effects are similar to those of oxybutynin but, because of bladder selectivity, may be less severe.Adverse effects are similar to those of oxybutynin but, because of bladder selectivity, may be less severe. |
DicyclomineDicyclomine | Smooth muscle relaxation, anticholinergic (antimuscarinic) effects | Dicyclomine has not been well-studied.Dicyclomine has not been well-studied. |
FesoterodineFesoterodine | Anticholinergic effects, selective M3 muscarinic antagonism | This prodrug has the same active metabolite as tolterodine.This prodrug has the same active metabolite as tolterodine. The dose should not exceed 4 mg once a day in patients with renal impairment. Adverse effects are similar to those of oxybutynin.Adverse effects are similar to those of oxybutynin. |
FlavoxateFlavoxate | Smooth muscle relaxation, anticholinergic (antimuscarinic) effects | Flavoxate is usually ineffective.Flavoxate is usually ineffective. Adverse effects include nausea, vomiting, dry mouth, and blurred vision. Adverse effects are tolerable with doses of up to 1200 mg/day. |
HyoscyamineHyoscyamine | Anticholinergic effects | Hyoscyamine has not been well-studied.Hyoscyamine has not been well-studied. |
ImipramineImipramine | Tricyclic antidepressant, anticholinergic, and alpha-agonist effects | Imipramine is useful for nocturia and mixed incontinence caused by detrusor overactivity and bladder outlet incompetence.Imipramine is useful for nocturia and mixed incontinence caused by detrusor overactivity and bladder outlet incompetence. |
MirabegronMirabegron | Beta-3 adrenergic agonist | Mirabegron is used to treat overactive bladder (urgency with or without urge incontinence and usually with Mirabegron is used to treat overactive bladder (urgency with or without urge incontinence and usually withurinary frequency). It may increase blood pressure. |
VibegronVibegron | Beta-3 adrenergic agonist | Vibegron is used to treat overactive bladder (urgency with or without urge incontinence and usually with urinary frequency).Vibegron is used to treat overactive bladder (urgency with or without urge incontinence and usually with urinary frequency). If urinary retention develops, discontinue vibegron.If urinary retention develops, discontinue vibegron. |
OnabotulinumtoxinA (botulinum toxin product)OnabotulinumtoxinA (botulinum toxin product) | Blockage of neuromuscular transmission by binding to receptor sites on nerve terminals and inhibiting the release of acetylcholine | OnabotulinumtoxinA is injected cystoscopically.OnabotulinumtoxinA is injected cystoscopically. It is used to treat adults with overactive bladder or neurogenic urge incontinence if they have an inadequate response to or cannot tolerate anticholinergic drugs. |
OxybutyninOxybutynin | Smooth muscle relaxation; anticholinergic, nonselective antimuscarinic, and local anesthetic effects | Oxybutynin is the most effective drug used to treat detrusor overactivity responsible for urge or stress incontinence.Oxybutynin is the most effective drug used to treat detrusor overactivity responsible for urge or stress incontinence. Efficacy may increase over time. Adverse effects include anticholinergic effects (eg, dry mouth, constipation), which may interfere with adherence and worsen incontinence. Adverse effects are less severe with extended-release and transdermal forms. |
PropanthelinePropantheline | Anticholinergic effects | Propantheline has largely been replaced by newer drugs that have fewer adverse effects.Propantheline has largely been replaced by newer drugs that have fewer adverse effects. This drug must be taken on an empty stomach. |
SolifenacinSolifenacin | Anticholinergic effects, selective M1 and M3 muscarinic antagonism | Adverse effects are similar to those of oxybutynin but, because of bladder selectivity, may be less severe.Adverse effects are similar to those of oxybutynin but, because of bladder selectivity, may be less severe. |
TolterodineTolterodine | Anticholinergic effects, selective M3 muscarinic antagonism | Efficacy and adverse effects are similar to those of oxybutynin, but long-term experience is limited.Efficacy and adverse effects are similar to those of oxybutynin, but long-term experience is limited. Because M3 receptors are targeted, adverse effects are less severe than those of oxybutynin.receptors are targeted, adverse effects are less severe than those of oxybutynin. Dose reduction is needed in patients with severe renal impairment. |
TrospiumTrospium | Anticholinergic effects | Adverse effects are similar to those of oxybutynin.Adverse effects are similar to those of oxybutynin. Dose reduction is needed in patients with severe renal impairment. |
Detrusor underactivity in overflow incontinence | ||
BethanecholBethanechol | Cholinergic effects | Bethanechol is usually ineffective.Bethanechol is usually ineffective. Adverse effects include flushing, tachycardia, abdominal cramps, and malaise. |
* Other prostate surgical procedures rarely cause established incontinence. | ||