7.4.2 Drugs for Urinary Frequency and Incontinence

Urinary Frequency Due to Overactive Bladder (symptoms)

Prescribing Notes

• Refer to NICE CG97 and NICE NG123.
• Conservative management is the first line treatment, such as bladder training, supervised pelvic floor muscle training and lifestyle advice.
• Pharmacotherapy as above confers a high anticholinergic burden score. As well as the known side effects of dry mouth, constipation, blurred vision, confusion and falls there is increasing evidence that a high anticholinergic burden is associated with worsening cognition, an increased risk of dementia, major adverse cardiovascular events and all-cause mortality. The decision to start anticholinergics should be considered carefully (especially in older and vulnerable patients), taking into account co-existing conditions and total anticholinergic burden. The lowest effective dose should be used, on-going treatment should be reviewed regularly and drug holidays sought where possible.
• A number of risk scales and calculators are available to assess and review anticholinergic burden e.g. ACB calculator.
• Mirabegron and Vibegron are only recommended as an option for treating the symptoms of overactive bladder in adults for whom antimuscarinic drugs are contraindicated or clinically ineffective, or have unacceptable side effects. See NICE TA 290 and TA999.

Cautions

• Pharmacotherapy as above confers a high anticholinergic burden score. As well as the known side effects of dry mouth, constipation, blurred vision, confusion and falls there is increasing evidence that a high anticholinergic burden is associated with worsening cognition, an increased risk of dementia, major adverse cardiovascular events and all-cause mortality. The decision to start anticholinergics should be considered carefully (especially in older and vulnerable patients), taking into account co-existing conditions and total anticholinergic burden. The lowest effective dose should be used, on-going treatment should be reviewed regularly and drug holidays sought where possible.
• There is risk of severe hypertension and associated cerebrovascular and cardiac events with mirabegron. For further details see MHRA.