7.4. Drugs for genito-urinary disorders
7.4.1. Drugs for urinary retention
Prescribing Notes:
Capsules are the most cost-effective preparation. Tamsulosin MR tablets are non-Formulary
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
Only suitable for patient with enlargement of the prostate.
7.4.2. Drugs for urinary frequency, enuresis, and incontinence
Prescribing Notes:
To be used 3rd line if Preferred List antimuscarinics are ineffective or as alternative 1st line treatment if antimuscarinics are contra-indicated. Refer to NHSGGC OAB treatment pathway (in development).
Prescribing Notes:
Most patients will respond adequately to the lower 5mg dose which should be trialled for 6-8 weeks before considering a dose increase. When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
Prescribing Notes:
When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
Restrictions:
Use for the management of bladder dysfunction (overactive bladder with symptoms of urinary incontinence, urgency and frequency) is restricted to specialist use in adult patients who have failed appropriate oral treatment options. Use in the management of urinary incontinence in adult patients with neurogenic detrusor overactivity due to subcervical spinal cord injury (traumatic or non-traumatic) or multiple sclerosis, who are not adequately managed with anticholinergics is restricted to specialist use.
Prescribing Notes:
Prescribe by brand name.
Restrictions:
Desmopressin oral lyophilisate for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults is restricted to specialist initiation by a consultant gynaecologist/urogynaecologist for use in patients aged 65 years and above (also see prescribing notes below).
Prescribing Notes:
- A positive diagnosis should be made following analysis of a 3-day volume chart
- Assessment of efficacy is required every 3 months
- Monitoring arrangements will be the responsibility of secondary care
Prescribing Notes:
Pelvic floor exercises are considered the first line treatment for stress incontinence in women.
Prescribing Notes:
When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
Prescribing Notes:
Oxybutynin should be used with caution in older patients following evidence of potential cognitive impairment. When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
Prescribing Notes:
Oxybutynin should be used with caution in older patients following evidence of potential cognitive impairment. When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
Prescribing Notes:
Oxybutynin should be used with caution in older patients following evidence of potential cognitive impairment. Other oxybutynin preparations are included in the Total Formulary. When prescribing antimuscarinics, consideration should be given to other factors which may influence the patient’s condition and response to treatment (e.g. excessive intake of fluid and other lifestyle choices).
7.4.3. Drugs used in urological pain
Restrictions:
Restricted to specialist intiation for the treatment of bladder pain syndrome characterised by either glomerulations or Hunner's lesions in adults with moderate to severe pain, urgency and frequency of micturition where other treatment options have failed, are not tolerated or are not appropriate.
7.4.4. Bladder instillations and urological surgery
7.4.5. Drugs for erectile dysfunction
Prescribing Notes:
Available for hospital and community prescribing but NHS prescribing by GPs is limited to nationally determined patient groups and schedule 11 restrictions. Please follow Board referral guidance for men suffering erectile dysfunction, including approval for GP prescribing for erectile dysfunction causing severe distress. Consult Summary of Product Characteristics on drug interactions prior to prescribing.
Restrictions:
Restricted to specialist initiation for use in patients who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non-injectable formulations of erectile dysfunction medications.
Restrictions:
Restricted to use for erectile dysfunction or for pulmonary arterial hypertension (see section 2.4.1). Use for benign prostatic hyperplasia is not recommended for use by SMC and is non-Formulary.
Prescribing Notes:
Available for hospital and community prescribing but NHS prescribing by GPs is limited to nationally determined patient groups and schedule 11 restrictions. Please follow Board referral guidance for men suffering erectile dysfunction, including approval for GP prescribing for erectile dysfunction causing severe distress. Consult Summary of Product Characteristics on drug interactions prior to prescribing.
Restrictions:
Excludes orodispersible tablets.
Prescribing Notes:
Available for hospital and community prescribing but NHS prescribing by GPs is limited to nationally determined patient groups and schedule 11 restrictions. Please follow Board referral guidance for men suffering erectile dysfunction, including approval for GP prescribing for erectile dysfunction causing severe distress. Consult Summary of Product Characteristics on drug interactions prior to prescribing.