ADVICE ON THE TREATMENT OF
1) Advise patients about sensible fluid intake
2) Advise about decreasing intake of caffeine containing drinks such as tea, coffee and cola.
3) Take the last drink in the evening several hours before retiring to bed.
4) Home bladder training. Advice about increasing the time between each visit to the toilet
5) Try to substitute diuretic treatments, e.g. Bendrofluazide for hypertension, to non-diuretic therapies.
6) Drug treatments: - (These can be used in combination if required)
a. In post-menopausal patient – systemic oestrogen therapy or local oestrogen. This appears to alleviate symptoms of urgency, urge incontinence, frequency, mocturia and dysuria.
b. Detrusitol XL (long-acting) 4mg nocte or, with more side effects, Detrusitol 2mg bd.
c. Regurin (Trospium chloride) 20mg bd. In the elderly use as a first line drug as it has no documented CNS. 80% of Trospoium chloride is secreted unchanged in the urine and the other 20% in the faeces and is quoted as having no metabolic drug interactions. It may be reasonable to start at 20mg bd and increase to 40mg bd. It has not had any reported drug interactions (cf Detrusitol XL interacts with codeine, fluoxetine, erythromycin, antifungals and H2 antagonists).
d. Lyrinel XL [previous brand name Ditropan] (long-acting) 5mg nocte which can be increased up to 30mg od in 5mg increments weekly. There is probably no role for ordinary oxybutynin nowadays although it is the first line with NICE.
e. Solifenacin (Vesicare). Dose 5mg nocte, increased to 10mg nocte if required.
f. Darifenacin (Emselex) 7.5mg nocte.
g. Detrunorm (propiverine hydrochloride) XL 30mg nocte.
h. Fesoterodine (Toviaz) 4mg nocte
i. Kentera – transdermal Oxybutynin patch. One 3.0g transdermal patch twice weekly.
j. Imipramine hydrochloride nocte. This can be started at a dose of 25mg nocte and increased gradually to a maximum of 150mg nocte. This may be particularly effective for nocturia.
k. Desmopressin (20-40 micrograms nasal spray). This can be taken by those without any cardiac disease when there is appreciable nocturia. It is taken as a nasal spray and it turns off urine production for several hours., There is a compensatory diuresis for approximately ten hours. Desmopressin is also available as Desmotabs 0.2mg to 0.4mg. This is said to be as effective as the spray and may be better tolerated..
l. Advice for Patience having botox treatment. for sheet click here.
I hope these ideas are useful.