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NICE endorses darifenacin for urinary incontinence

By News team

Once-daily darifenacin has been included as an option for first-line therapy in a for the management of women with urinary incontinence.

The guideline was published by the National Institute for Health and Care Excellence last week (11 September 2013) and updates one . It states that women with overactive bladder syndrome (OBS) or mixed urinary incontinence should be offered a choice of immediate-release oxybutynin (but not for frail older women), immediate-release tolterodine or once-daily darifenacin as first-line treatment. If the first treatment is not effective or well tolerated another drug with the lowest acquisition cost should be offered, it says. This could be from any of the drugs reviewed, including various formulations of oxybutynin, tolterodine, darifenacin, fesoterodine, propiverine, solifenacin and trospium.

NICE specifies that women with OBS should be offered a face-to-face or telephone review four weeks after the start of each new drug treatment.

For women with OBS who have not responded to "conservative management", bladder wall injections with Botulinum toxin should be offered after discussing the risks and benefits, says NICE. The guideline notes that most Botulinum toxin type A preparations do not currently have a UK marketing authorisation for this indication.

Urinary incontinence affects an estimated five million women aged over 20 years in England and Wales.

Citation: Electronicjuice DOI: 10.1211/PJ.2013.11125821

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