NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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7 Obstetrics, gynaecology and urinary-tract disorders

7.4 Drugs for genito-urinary disorders

7.4.1 Drugs for urinary retention

Preferred list
TAMSULOSIN (modified-release capsules)

Prescribing Notes:

Capsules are the most cost-effective preparation. Tamsulosin MR tablets are non-Formulary

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/39351.htm

Total Formulary
DUTASTERIDE

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

Only suitable for patient with enlargement of the prostate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/127920.htm

7.4.2 Drugs for urinary frequency, enuresis, and incontinence

Preferred list
OXYBUTYNIN (STANDARD RELEASE TABLETS)

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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4633.htm

SOLIFENACIN

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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129099.htm

TOLTERODINE

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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/70145.htm

Total Formulary
FESOTERODINE FUMARATE

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).

BNF Link: http://bnf.org/bnf/bnf/current/201012.htm

OXYBUTYNIN (MR TABLETS)

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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/88024.htm#_88024

OXYBUTYNIN (TRANSDERMAL PATCH)

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).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129279.htm

DULOXETINE

Prescribing Notes:

Pelvic floor exercises are considered the first line treatment for stress incontinence in women.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129097.htm

BOTULINUM TOXIN A (BOTOX)

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.

7.4.3 Drugs used in urological pain

Total Formulary
SODIUM BICARBONATE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4649.htm

7.4.4 Bladder instillations and urological surgery

Total Formulary
NOXYTHIOLIN

Restrictions: Restricted to specialist initiation.

DIMETHYL SULFOXIDE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4657.htm

GLYCINE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4666.htm

7.4.5 Drugs for erectile dysfunction

Preferred list
SILDENAFIL

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.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/74209.htm

Total Formulary
ALPROSTADIL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/18535.htm

TADALAFIL

Restrictions: Restricted to use for erectile dysfuntion 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.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119672.htm

VARDENAFIL

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.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/127954.htm