BNF for Children 2011-2012

BNFC 2011–2012 7.4.2 Drugs for urinary frequency, enuresis, and incontinence 411Child 5–12 years 2.5–3 mg twice daily, increasedto 5 mg 2–3 times dailyChild 12–18 years 5 mg 2–3 times daily,increased if necessary to max. 5 mg 4 times daily. By intravesical instillationChild 2–18 years 5 mg 2–3 times dailyNocturnal enuresis associated with overactivebladder. By mouthChild 5–18 years 2.5–3 mg twice daily increasedto 5 mg 2–3 times daily (last dose before bedtime)Oxybutynin Hydrochloride (Non-proprietary) ATablets, oxybutynin hydrochloride 2.5 mg, net price56-tab pack = £6.58; 3 mg, 56-tab pack = £9.15; 5 mg,56-tab pack = £5.53, 84-tab pack = £12.50. Label: 3Intravesical instillation, oxybutynin (as hydrochloride)5 mg/30 mL.Available from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Cystrin c (Winthrop) ATablets, oxybutynin hydrochloride 5 mg (scored), netprice 84-tab pack = £21.99. Label: 3Ditropan c (Sanofi-Aventis) ATablets, both blue, scored, oxybutynin hydrochloride2.5 mg, net price 84-tab pack = £6.59; 5 mg, 84-tabpack = £12.82. Label: 3Modified releaseLyrinel c XL (Janssen) ATablets, m/r, oxybutynin hydrochloride 5 mg (yellow),net price 30-tab pack = £10.81; 10 mg (pink), 30-tab pack = £21.62. Label: 3, 25DoseNeurogenic bladder instability. By mouthChild 6–18 years initially 5 mg once daily adjustedaccording to response in steps of 5 mg at weekly intervals;max. 15 mg once dailyNote Children taking immediate-release oxybutynin may betransferred to the nearest equivalent daily dose of Lyrinel cXLTOLTERODINE TARTRATECautions see notes above; history of QT-interval prolongation;concomitant use with other drugs known toprolong QT intervalContra-indications see notes aboveHepatic impairment reduce dose; avoid Detrusitolc XLRenal impairment reduce dose if estimated glomerularfiltration rate less than 30 mL/minute/1.73 m 2 ;avoid Detrusitol c XL if estimated glomerular filtrationrate less than 30 mL/minute/1.73 m 2Pregnancy manufacturer advises avoid—toxicity inanimal studiesBreast-feeding manufacturer advises avoid—noinformation availableSide-effects see notes above; also chest pain, peripheraloedema; sinusitis, bronchitis; paraesthesia,fatigue, vertigo, weight gain; flushing also reportedLicensed use not licensed for use in childrenIndication and doseUrinary frequency, urgency, incontinence. By mouthChild 2–18 years 1 mg once daily, increasedaccording to response; max. 2 mg twice dailyNocturnal enuresis associated with overactivebladder. By mouthChild 5–18 years 1 mg once daily at bedtime,increased according to response; max. 2 mg twicedailyDetrusitol c (Pharmacia) ATablets, f/c, tolterodine tartrate 1 mg, net price 56-tabpack = £29.03; 2 mg, 56-tab pack = £30.56Modified releaseDetrusitol c XL (Pharmacia) ACapsules, blue, m/r, tolterodine tartrate 4 mg, netprice 28-cap pack = £25.78. Label: 25Note Children stabilised on immediate-release tolteridone2 mg twice daily may be transferred to Detrusitol c XL 4 mgonce dailyNocturnal enuresisNocturnal enuresis is common in young children, butpersists in a small proportion by 10 years of age. Forchildren under 5 years, reassurance and advice on themanagement of nocturnal enuresis can be useful forsome families. Treatment may be considered in childrenover 5 years depending on their maturity and motivation,the frequency of nocturnal enuresis, and the needsof the child and their family.Initially, advice should be given on fluid intake, diet,toileting behaviour, and reward systems; for childrenwho do not respond to this advice, further treatmentmay be necessary. An enuresis alarm should be firstlinetreatment for motivated, well supported children;alarms have a lower relapse rate than drug treatmentwhen discontinued. Treatment should be reviewed after4 weeks, and, if there are early signs of response,continued until a minimum of 2 weeks’ uninterrupteddry nights have been achieved. If complete dryness isnot achieved after 3 months, only continue if the conditionis still improving and the child remains motivatedto use the alarm. If initial alarm treatment is unsuccessful,consider combination treatment with desmopressin(see below), or desmopressin alone if the alarm is nolonger appropriate or desirable.Desmopressin (section 6.5.2), an analogue of vasopressin,is given by oral or by sublingual administration;it should not be given intranasally for nocturnal enuresisdue to an increased incidence of side-effects. Desmopressinalone can be offered to children over 5 years ofage if an alarm is inappropriate or undesirable, or whenrapid or short-term results are the priority (for exampleto cover periods away from home); desmopressin alonecan also be used if there has been a partial response to acombination of desmopressin and an alarm followinginitial treatment with an alarm. Treatment should beassessed after 4 weeks and continued for 3 months ifthere are signs of response. Desmopressin should bewithdrawn at regular intervals (for 1 week every 3months) for full reassessment. Particular care is neededto avoid fluid overload by restricting fluid intake from7 Obstetrics, gynaecology, and urinary-tract disorders