netFormulary NHS
Nottinghamshire Area Prescribing Committee  
 Search
 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
07.04.02  Expand sub section  Drugs for urinary frequency, enuresis, and incontinence
07.04.02  Expand sub section  Urinary incontinence
Oxybutynin

View adult BNF  View SPC online  View childrens BNF
First Choice
Green
Tablets, patches.
  • Liquid - Instead use patches, or if needed ordinary release tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • For place in therapy of oxybutynin see Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline. See unexpectedly expensive medicines list.
  • MR tablets expensive compared to standard tablets.

    Link  Cost comparison of treatments for hypersalivation
    Link  Link to reviews  
  • Tolterodine

    View adult BNF  View SPC online  View childrens BNF
    First Choice
    Green
    Tablet (1mg and 2mg)
  • For place in therapy of tolterodine see Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
  • MR capsules expensive compared to standard release
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
     
  • Trospium

    View adult BNF  View SPC online  View childrens BNF
    Second Choice
    Amber 3
    Tablet
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
     
  • Darifenacin (Emselex®)

    View adult BNF  View SPC online  View childrens BNF
    Second Choice
    Amber 3
    Tablet
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline

    Link  Link to reviews  
  • Fesoterodine (Toviaz®)

    View adult BNF  View SPC online  View childrens BNF
    Second Choice
    Amber 3
    Tablet
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline

    Link  Link to reviews  
  • Propiverine (Detrunorm®)

    View adult BNF  View SPC online  View childrens BNF
    Second Choice
    Amber 3
    Tablets
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
  • MR capsules expensive compared to standard tablets

    Link  Link to reviews  
  • Solifenacin (Vesicare®)

    View adult BNF  View SPC online  View childrens BNF
    Second Choice
    Amber 3
    Tablets
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
  • If needed tablets can be dispersed in water. Do not crush first as the powder is allegedly 'irritant to eyes'. See here for general advice on dispersing tablets.

    Link  Link to reviews  
  • Mirabegron (Betmiga®)

    View adult BNF  View SPC online  View childrens BNF
    Third Choice
    Amber 3
    Tablets
  • GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
    Only to be used instead of anticholinergics if:
  • anticholinergics contraindicated
  • severe side effects with anticholinergics
  • at least two anticholinergics not effective
    Prescribing mirabegron in combination with anticholinergics is not supported by trial data and therefore non-formulary

    Link  Click here for independent drug reviews
    Link  MHRA: risk of severe hypertension and associated CV events with mirabegron
    Link  NICE: TA290 - Mirabegron for overactive bladder  
  • Duloxetine (Yentreve®)

    View adult BNF  View SPC online  View childrens BNF
    Formulary
    Amber 2
    Capsules
  • On recommendation of stress incontinence team.
  • If needed capsules can be opened and beads mixed with water (do not crush). More Info

    Link  Link to reviews  
  • Oxybutynin Intra-vesical
    (5mg/30ml)

    View adult BNF  View SPC online  View childrens BNF
    Restricted Drug Restricted
    Red
    Unlicensed, named patient use- secondary care only
     
    07.04.02  Expand sub section  Nocturnal enuresis
    07.04.02  Expand sub section  antimuscarinics
     ....
     Non Formulary Items
    Flavoxate (Urispas 200®)


    View adult BNF  View SPC online  View childrens BNF
    Non Formulary
    Grey

     
    Imipramine


    View adult BNF  View SPC online  View childrens BNF
    Non Formulary
    Grey
    Tablet
     
    Propantheline


    View adult BNF  View SPC online  View childrens BNF
    Non Formulary
    Grey

     
    Solifenacin and Tamsulosin (Vesomni®)


    View adult BNF  View SPC online  View childrens BNF
    Non Formulary
    Grey
  • Reviewed and rejected as not thought to offer significant benefits for the health community. Oxybutynin and tolterodine are first line anticholinergics and should be used as per the LUTS guideline. (APC May 2014)


    Link  Link to reviews  
  • Trospium (Regurin® XL )


    View adult BNF  View SPC online  View childrens BNF
    Non Formulary
    Grey
  • Modified release preparation, classified as
  • See above for normal release formulary entry
     
  •   
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
    click to search medicines.org.uk
    Link to SPCs
    click to search medicines.org.uk
    Link to adult BNF
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to children's BNF
    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Grey   Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      
      Red   Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      
      Amber 1   Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      
      Amber 2   Medicines suitable to be prescribed in primary care after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      
      Amber 3   Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      
      Green   Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    netFormulary