Bladder spasm . overactive bladder, treatment options

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Urology - Bladder spasm

Belladonna and opium - B&O Supprettes ®

Drug Category: Analgesic Combination. Urinary Antispasmodic Agent.

Use: Relief of moderate to severe pain associated with rectal or bladder tenesmus that may occur in postoperative states and neoplastic situations. Pain associated with ureteral spasms not responsive to non-narcotic analgesics and to space
intervals between injections of opiates.

Dosing (Adults): 1 suppository rectally once or twice daily. Max 4 doses/day.

Supplied: #15 A: Belladonna extract 16.2 mg and opium 30 mg. #16 A: Belladonna extract 16.2 mg and opium 60 mg.

flavoxate (Urispas ®)

Dosing (Adults): 100-200 mg orally 3 to 4 times daily.

hyoscyamine (Levsin ®)

Dosing (Adults): 0.125 to 0.375 mg orally or sublingual every 4 hours as needed. Max 1.5 grams/ day.
Long acting (XL): 0.375 - 0.75 mg orally every 12 hours.

Bladder instability (Overactive bladder)

darifenacin (Enablex ® )

Anticholinergic agent. Dosing (Adults): Symptoms of bladder overactivity - Initial: 7.5 mg orally once daily. If response is not adequate after a minimum of 2 weeks, dosage may be increased to 15 mg once daily. Dosage should not be increased in patients with hepatic impairment or in those receiving potent inhibitors of CYP3A4.

Hepatic dosing: Moderate impairment (Child-Pugh Class B): Daily dosage should not exceed 7.5 mg/day. Severe impairment (Child-Pugh Class C): Use is not recommended.

Supplied: Extended release tablet: 7.5 mg, 15 mg.

oxybutynin (Ditropan ®)

Exhibits 20% of the anticholinergic activity of atropine, however, has 4 to 10 times the antispasmodic activity.

Dosing (Adults): Bladder spasms: Regular release: 5 mg orally 2 to 3 times daily up to maximum of 5 mg 4 times/day. Extended release (XL): Initial: 5-10 mg once daily- may increase in 5-10 mg increments. Maximum: 30 mg daily. Transdermal: Apply one 3.9 mg/day patch twice weekly (every 3-4 days). Note: Should be discontinued periodically to determine whether the patient can manage without the drug and to minimize resistance to the drug.

Supplied: Regular release tablet: 5 mg. Extended release tablet: 5 mg, 10 mg, 15 mg. Syrup: 5 mg/5 ml. Transdermal system (Oxytrol ®): 3.9 mg/day.

solifenacin (Vesicare ® )

Anticholinergic agent -Inhibits muscarinic receptors resulting in decreased urinary bladder contraction, increased residual urine volume, and decreased detrusor muscle pressure.
Dosing (Adults): Overactive bladder: 5 mg orally once daily. If tolerated, may increase to 10 mg orally once daily.

Renal Dosing: Use with caution in patients with reduced renal function ( Clcr <30 ml/minute: 5 mg/day).

Hepatic impairment: Use with caution in reduced hepatic function: Moderate: 5 mg/day. Severe impairment: Not recommended.

Supplied: 5 mg, 10 mg tablet.

tolterodine (Detrol ® )

Anticholinergic agent -demonstrates selectivity for urinary bladder receptors over salivary receptors.
Dosing (Adults): Immediate release tablet: 2 mg orally twice daily. The dose may be lowered to 1 mg twice daily based on individual response and tolerability.
Extended release capsule: 4 mg once a day- dose may be lowered to 2 mg daily based on individual response and tolerability.

Renal Dosing (Crcl 10-30)/ hepatic impairment: Use with caution. 1 mg twice daily (regular release) or 2 mg daily (extended release).

Supplied: 1 mg, 2 mg tablet. 2 mg, 4mg extended release capsule.

trospium (Sanctura ® )

Dosing (Adults): Overactive bladder - 20 mg orally twice daily. In patients >75 years old or if crcl < 30 ml/min decrease dose to 20 mg once daily at bedtime.

Supplied: 20 mg tablet.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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