Drugs for genito-urinary disorders

Drugs for urinary retention

Chronic retention is painless and often long-standing. Catheterisation is unnecessary unless there is deterioration of renal function. After the cause has initially been established and treated, drugs may be required to increase detrusor muscle tone. Benign prostatic hyperplasia is treated either surgically or medically with alpha-blockers. Dutasteride and finasteride are alternatives to alpha­blockers, particularly in men with a significantly enlarged prostate.

ALFUZOSIN HYDROCHLORIDE:

Indications: Benign prostatic hyperplasia

Contraindications: Alpha-blockers should be avoided in patients with a history of postural hypotension and micturition syncope.

Dose and Administration: Acute urinary retention associated with benign prostatic hyperplasia in men over 65 years, 10 mg once daily for 2–3 days during catheterisation and for one day after removal; max. 4 days.

Doxazosin:

Indications: treatment of both the urinary outflow obstruction and obstructive and irritative symptoms associated with BPH. also indicated for the treatment of hypertension alone or in combination with diuretics, beta-adrenergic blocking agents, calcium channel blockers or angiotensin-converting enzyme inhibitors.

Contraindications: Fainting, Priapism, Severe Hepatic Disease.

Dose and Administration: Benign Prostatic Hyperplasia 1–8 mg once daily. Hypertension 1–16 mg once daily.

TAMSULOSIN HYDROCHLORIDE:

Indications: Benign Prostatic Hypertrophy.

Contraindications: Micturition Syncope, Intraoperative Floppy Iris Syndrome,

Orthostatic Hypotension, and Priapism.

Dose and Administration: 400 micrograms daily as a single dose.

TERAZOSIN:

Indications: Benign Prostatic Hypertrophy, Hypertension.

Contraindications: Fainting, Orthostatic Hypotension, Priapism.

Dose and Administration: Initially 1 mg at bedtime; if necessary dose may be doubled at intervals of 1–2 weeks according to response, up to max. 10 mg once daily; usual maintenance 5–10 mg daily.

Drugs for urinary frequency, enuresis, and incontinence

SOLIFENACIN SUCCINATE:

Indications: urinary frequency, urgency and urge incontinence.

Contraindications: severe hepatic impairment, haemodialysis; breast-feeding.

Dose and Administration: 5 mg daily, increased if necessary to 10 mg once daily; child not recommended.

TOLTERODINE TARTRATE:

Indications: urinary frequency, urgency and incontinence

Contraindications: pregnancy and breast-feeding.

Dose and Administration: adult over 18 years, 2 mg twice daily; reduce to 1 mg twice daily if necessary to minimise side-effects. adult over 18 years, 4 mg once daily (dose form not appropriate for hepatic impairment or if creatinine clearance less than 30 mL/minute)

OXYBUTYNIN HYDROCHLORIDE:

Indications: urinary frequency, urgency and incontinence, neurogenic bladder instability, and nocturnal enuresis associated with overactive bladder.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: adult and child over 12 years, initially 5 mg 2–3 times daily, increased if necessary to max. 5 mg 4 times daily; elderly initially 2.5–3 mg twice daily, increased to 5 mg twice daily according to response and tolerance; child 5–12 years, neurogenic bladder instability, 2.5–3 mg twice daily, increased to 5 mg 2–3 times daily; child under 5 years, see BNF for Children; child 7–18 years, nocturnal enuresis associated with overactive bladder, 2.5–3 mg twice daily increased to 5 mg 2–3 times daily (last dose before bedtime)

Preparations for Urolithiasis

ANETHOL, BORNEOL, FENCHONE, CAMPHENE & CINEOL: 

Indications: urolithiasis, nephrolithiasis and other renal and urinary disorders.

Contraindications: hypersensitivity to any of the ingredients.

Dose and Administration: one capsule 3-4 times daily, half an hour before meals.

POTASSIUM SODIUM HYDROGEN CITRATE:

Indications: for dissolving uric acid stones and preventing the formulation of

new stones.

Contraindications: in patients with acute or chronic renal failure or when

sodium chloride is totally forbiden.

Dose and Administration: the daily dose is 4 measuring spoonfuls taken in

three sparate portions after meals.

Drugs used in Urological Pain

HEXAMINE:

Indications: prophylaxis and long-term treatment of chronic or recurrent lower urinary-tract infections.

Contraindications: hepatic impairment, renal impairment, severe dehydration, gout, and metabolic acidosis.

Dose and Administration: 1 g every 12 hours (may be increased in patients with catheters to 1 g every 8 hours); child 6–12 years 500 mg every 12 hours.

TROSPIUM CHLORIDE:HERBAL( Extr. Sabal serrulatae sicc.25 mg Extr. Echinaceae sicc.30 mg)+Trospium chloride 2 mg

Indications: for all forms of spasmodic pain associated with micturition, for frequency or difficulty in emptying the bladder

resulting from disease of the bladder, prostate or urethra or caused by other states of urinary tract irritation.

Contraindications: should not be used in glaucoma, advanced benign prostatic enlargment

Dose and Administration:           2 tablets 3 times daily after meals.

Drugs for erectile dysfunction

ALPROSTADIL:

Indications: erectile dysfunction (including aid to diagnosis); neonatal congenital heart defects.

Contraindications: predisposition to prolonged erection (as in sickle cell anaemia, multiple myeloma or leukaemia); not for use with other agents for erectile dysfunction, in patients with penile implants or when sexual activity medically inadvisable; urethral application also contra-indicated in urethral stricture, severe hypospadia, severe curvature, balanitis, urethritis.

Dose and Administration: By direct intracavernosal injection, adult over 18 years, erectile dysfunction, first dose 2.5 micrograms, second dose 5 micrograms (if some response to first dose) or 7.5 micrograms (if no response to first dose), increasing in steps of 5–10 micrograms to obtain dose suitable for producing erection lasting not more than 1 hour (neurological dysfunction, first dose 1.25 micrograms, second dose 2.5 micrograms, third dose 5 micrograms, increasing in steps of 5–10 micrograms to obtain suitable dose); if no response to dose then next higher dose can be given within 1 hour, if there is a response the next dose should not be given for at least 24 hours; usual dose 5–20 micrograms; max. 60 micrograms; max. frequency of injection not more than 3 times per week with at least 24 hour interval between injections.

SILDENAFIL:

Indications: erectile dysfunction; pulmonary hypertension.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction.

Dose and Administration: adult over 18 years initially 50 mg approx. 1 hour before sexual activity.

TADALAFIL:

Indications: erectile dysfunction.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction. also moderate heart failure, uncontrolled arrhythmias, uncontrolled hypertension

Dose and Administration: adult over 18 years initially 20 mg approx. half an hour before sexual activity.

VARDENAFIL:

Indications: erectile dysfunction.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction. also moderate heart failure, uncontrolled arrhythmias, uncontrolled hypertension also hereditary degenerative retinal disorders.

Dose and Administration: adult over 18 years initially 20 mg approx. half an hour before sexual activity.