netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Chapter Links...
 Details...
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
  • 2.5mg and 5mg tablets
  • 2.5mg in 5ml & 1mg/1ml oral solution
  • Immediate release oxybutinin is not appropriate for frail elderly people or those with cognitive impairment.

 

 
Solifenacin
View adult BNF View SPC online View childrens BNF
First Choice
Green

  • 5mg and 10mg tablets 

 
Tolterodine 1mg and 2mg tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Darifenacin
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • MR Tablets - 7.5mg, 15mg
 
 
Duloxetine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Capsules: 20mg, 40mg
  • Moderate to severe stress incontinence in combination with supervised pelvic floor excercises only
 
 
Fesoterodine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  •  MR Tablets - 4mg, 8mg
 
 
Propiverine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Tablets: 15mg
 
 
Trospium
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Tablets: 20mg
 
 
Mirabegron
View adult BNF View SPC online View childrens BNF
Alternatives
Green

  • Approved for use when antimuscarinics don’t work, are not suitable or side effects are unacceptable, in line with NICE guidance. 

 
Link  NICE TA290: Mirabegron for overactive bladder
Link  MHRA Drug Safety Update (Oct 2015): Mirabegron†-†risk†of severe†hypertension†and†associated†cerebrovascular†and†cardiac events
 
Oxybutynin Hydrochloride - patch
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Oxybutinin patch 36mg (releases approximately 3.6mg in 24 hours). 
  • Approved for patients in whom two antimuscarinics have proved to be efficacious but the side effects are intolerable, or for patients who cannot swallow tablets.



 

 
 
Methylphenidate
(Giggle incontinence)
View adult BNF View SPC online View childrens BNF
Alternatives
Amber
  • Methylphenidate is approved for use as a third line option (after e.g. antimuscarinics, imipramine, and pelvic floor exercises) in the treatment of giggle incontinence in children. Its use should be subject to a therapeutic trial to be reviewed after two months and considered for Shared Care if patients have been shown to respond after the trial period.
  • The following methylphenidate formulations are approved for giggle incontinence:
    • 5mg & 10mg tablets.
    • 10mg, 20mg & 30mg m/r capsules (Equasym XL®).
    • 18mg, 27mg & 36mg m/r tablets (Xaggitin® XL)
  • Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
  • Xaggitin® XL is bioequivalent to Concerta® XL
  • The effects of Equasym® XL last for about 8 hours compared with about 12 hours for Xaggitin® XL. 
 
Link  MHRA Drug Safety Update (Sep 2022): Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
Link  North of Tyne, Gateshead and North Cumbria: Giggle Incontinence in children & young people aged 8 to 18 years
 
Vaginal Devices
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Vaginal Devices for female stress urinary incontinence (e.g. Diveen, Contiform, Efemia)
  • Approved for use in line with NTAG / NICE
  • Product should only be initiated by a specialist pelvic health physiotherapists and specialist nurses
 
Link  NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management
Link  NTAG: Vaginal devices for female urinary stress incontinence
 
07.04.02  Expand sub section  Nocturnal enuresis
07.04.02  Expand sub section  antimuscarinics
07.04.02  Expand sub section  beta3-adrenoceptor agonists to top
07.04.02  Expand sub section  botulinum toxin
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GPís prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patientís GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary