{ "schema_version": 1, "kind": "condition", "id": "urinary-incontinence-stress", "name": "Stress Urinary Incontinence (Female Adult)", "category": "chronic", "sources": "Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) · YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt)", "review_status": "reviewed", "verified_against": "Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) · YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) · Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence-stress-full.txt) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1815, "generic": "Duloxetine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 40.0, "adult_dose": "40 mg twice daily; re-evaluate after 4 weeks", "adult_duration": null, "dose_source": "YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441)", "rationale": "Serotonin-noradrenaline reuptake inhibitor that increases pudendal nerve input to the urethral sphincter, improving sphincter tone and closure; used for stress urinary incontinence when first-line pelvic floor muscle training has not been sufficient.", "cautions": [ "Pelvic floor muscle training (PFMT) for at least 3 months is FIRST-LINE conservative therapy.", "Nausea, dry mouth, insomnia, and dizziness are common during initiation; taper when discontinuing.", "Contraindicated in uncontrolled hypertension and liver disease resulting in hepatic impairment.", "The indication is on two documents now. The condition's own article has duloxetine raising the tone of the external urethral sphincter and cutting stress incontinence episodes markedly in as many as 64% of patients. The general urinary incontinence article names it under the pharmacologic management of stress incontinence, alongside vaginal estrogen cream.", "The same article's own reservation: outside Europe it judges the balance of benefit against risk for duloxetine in stress urinary incontinence to be unfavourable, Europe being where the drug is approved for moderate to severe cases. Weigh that before starting it, and it is why the drug is not FDA-approved for this use." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DEPRETREVE 20MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA", "price_egp": 62.0, "pack_count": 20, "unit_price": 3.1, "strength_mg": 20.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DULOPRESSIVE 20 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > TA PHARMA", "price_egp": 112.0, "pack_count": 30, "unit_price": 3.73, "strength_mg": 20.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPRETREVE 30MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA", "price_egp": 86.0, "pack_count": 20, "unit_price": 4.3, "strength_mg": 30.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KARBALTA 30 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 212.0, "pack_count": 28, "unit_price": 7.57, "strength_mg": 30.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KARBALTA 60 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 249.0, "pack_count": 30, "unit_price": 8.3, "strength_mg": 60.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CYMBALTA 30 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ELI LILLY", "price_egp": 399.0, "pack_count": 28, "unit_price": 14.25, "strength_mg": 30.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 231.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WADILOXTIN 60 MG 28 DEL. REL. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WADI ELNEEL BENTA", "price_egp": 280.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "urinary-incontinence-stress" }, { "id": 1817, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence-stress-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Refer to a urogynaecologist or urologist for: unexplained haematuria; recurrent UTIs; incontinence that is unusually severe, or that has not responded to medical treatment; marked bladder overactivity; prolapse, or pelvic anatomy that is abnormal; a neurological condition alongside it; previous surgery for incontinence, other significant pelvic surgery, or pelvic radiotherapy; and any case where the diagnosis is in doubt or urodynamic testing came back equivocal." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "urinary-incontinence-stress" }, { "id": 1816, "generic": "Estriol", "line": 1, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "One applicatorful (0.5 mg estriol) intravaginally once daily at bedtime; maintenance dose of one applicatorful twice a week may be used after restoration of the vaginal mucosa has been achieved", "adult_duration": null, "dose_source": "Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869)", "rationale": "Adjunct topical oestrogen added when stress incontinence occurs alongside postmenopausal vaginal atrophy, restoring urogenital tissue integrity; it treats the atrophic component and does not replace pelvic floor training or duloxetine.", "cautions": [ "Systemic absorption is minimal; systemic progestogen co-prescription is not required for vaginal estriol cream.", "The cream perishes rubber. A latex condom or diaphragm that has been in contact with it cannot be relied on for contraception.", "Review it yearly and try stopping every three to six months rather than repeating indefinitely.", "Breakthrough bleeding or spotting that starts on treatment, or carries on after stopping, needs investigating - biopsy included - to rule out endometrial cancer.", "Indicated for treatment of atrophic vaginitis and kraurosis in postmenopausal women.", "The indication is on two documents now. The condition's own article finds local topical estrogen of benefit to the postmenopausal woman with stress incontinence. The general urinary incontinence article names vaginal estrogen cream under the pharmacologic management of stress incontinence.", "The article's own frequency differs from the daily regimen the label sets: it describes a protocol in common use of 1 g or less per vaginal application, given 2 or 3 times a week. The dose printed here is the Gynest label's, which is the document that states a strength; the article's frequency is recorded so the difference is visible rather than hidden." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "OVESTIN 1 MG 20 TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO > SCHERING PLOUGH", "price_egp": 11.1, "pack_count": 20, "unit_price": 0.55, "strength_mg": 1.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "urinary-incontinence-stress" } ] }