Table 6. Pharmacotherapeutic Optionsa Drug (Brand)
Stress Incontinence α-Adrenergic agonists
Pseudoephedrine Sudafed® Generics
Urge Incontinence
Botulinum toxin Ab Botox®
Antimuscarinic
Darifenacin Enablex®
Solifenacin VESIcare®
Tolterodine Detrol®
Detrol LA®
Fesoterodine Toviaz™
Oxybutinin Ditropan®
Ditropan XL® Gelnique®
Trospium Sanctura®
Sanctura XR® Anticholinergic
Hyoscyamine Anaspaz® Cystospaz® Levsinex® Generics
0.375 mg bid
Dry mouth, headache, constipation, drowsiness, blurred vision, flushing
Contraindications: glaucoma, obstructive uropathy, GI obstructive or mobility disorder, myasthenia gravis Precautions: autonomic neuropathy, hyperthyroidism, hypertension, heart or renal disease
a Start with lowest dose and titrate up in frail and elderly patients. b FDA approved for detrusor overactivity associated with neurologic conditions.
(10% gel)
Oxytrol® Transdermal System
7-15 mg daily 5-10 mg daily
2 mg bid 1 mg bid in reduced renal or
hepatic function
2-4 mg daily 2 mg daily in reduced renal or hepatic function
4-8 mg daily
2.5-5 mg bid-tid (max 20 mg daily)
5-30 mg daily
Apply daily to dry skin
3.9 mg patch q3-4d
20 mg bid 20 mg hs in renal
impairment 60 mg qAM
Common: dry mouth, constipation, dyspepsia, somnolence
Less common: headache, nausea, abdominal pain, xerophthalmia, blurred vision
Pruritus or erythema (specific to topicals)
200 units
Urine infection, urine retention Cystoscopic intravesical
injection 15-30 mg tid
Nervousness, excitability, restlessness, weakness, insomnia
Contraindications: MAOIs Precautions: glaucoma, diabetes, hyperthyroidism, heart disease, hypertension
Typical Dose Side Effects Comments
Contraindications: urinary or gastric retention, uncontrolled narrow-angle glaucoma
Precautions: hepatic or renal impairment, bladder outflow obstruction, GI obstructive or mobility disorder, controlled narrow-angle glaucoma, myasthenia gravis, renal insufficiency, hepatic impairment
