Dosage reminders

When a patient starts a new medicine, help them to identify when they are going to take it and how they will set up systems to ensure they don’t forget – perhaps by writing it on a calendar, setting an audible reminder on a smart speaker, digital watch or smart phone, or involving carers or family members. Alongside other medicines, a ‘pill box organiser’ may help. 

Check they know what to do if they miss a dose by showing them the relevant section of the patient information leaflet (PIL). NICE recommends that the need for continuing therapy for urinary incontinence should be reviewed every four to six weeks until symptoms stabilise, and then every six to 12 months.

Side-effects 

Draw attention to the PIL to highlight common side-effects, ensuring the definition of “common” is explained in this context. 

As already mentioned, the main complaint about antimuscarinics is that they cause a dry mouth and constipation. There are some differences between antimuscarinics so using the PIL is helpful, both at the start of treatment and in subsequent conversations with patients about side-effects.  

• A substantial minority of patients discontinue antimuscarinics because of common side-effects. Ultimately the trade-off between side-effects and clinical benefit has to be an individual decision for each patient. Keeping a diary of frequency/urgency/leakage together with symptoms of possible side-effects can help in making this decision
• Common adverse effects of mirabegron include UTIs; headache and dizziness; tachycardia; nausea; constipation or diarrhoea
• Common adverse effects of duloxetine include insomnia; headaches; constipation or diarrhoea; dry mouth; sweating; loss of appetite; and sexual dysfunction
• Antimuscarinics can affect the performance of skilled tasks (e.g. driving)
• Offer advice about managing side-effects such as dry mouth and constipation in advance, as well as when they become troublesome, may be helpful
• Some of the more common side-effects are more likely to occur soon after starting treatment and some may subside. 

Interactions

Interactions can occur with other prescribed medicines and OTC products:

• Medicines that are associated with urinary incontinence include diuretics, ACE inhibitors and ARBs, and SSRIs
• HRT and vaginal oestrogen products may have been prescribed for vaginal atrophy or other menopause symptoms. If incontinence related to these conditions has not been discussed with the prescriber, the patient should be advised to raise this with them.