{ "schema_version": 1, "kind": "condition", "id": "urinary-incontinence", "name": "Urinary incontinence", "category": "acute", "sources": "EAU Guidelines on Non-neurogenic Male/Female LUTS 2023 · Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) · BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81)", "review_status": "reviewed", "verified_against": "Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) · Urinary Incontinence - disease-level clinical article (urinary-incontinence-clinical.txt) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) · BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81)", "verified_date": "2026-08", "treatments": [ { "id": 1812, "generic": "Solifenacin succinate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "5 mg once daily, may increase to 10 mg once daily if necessary.", "adult_duration": "As directed, long-term maintenance", "dose_source": "Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559)", "rationale": "Solifenacin at the standard starting dose is first-line drug treatment for urge-type urinary incontinence/overactive bladder once the type of incontinence is established and red-flag causes excluded.", "cautions": [ "New incontinence with back pain, saddle numbness, or leg weakness suggests cauda equina syndrome, a surgical emergency.", "Only helps the urge-incontinence/overactive-bladder component; it does not treat stress incontinence (leakage on coughing/sneezing/exertion) or overflow incontinence, so establish the type first.", "New incontinence with back pain, saddle numbness, or leg weakness needs urgent assessment for cauda equina syndrome, not this drug.", "CONTRAINDICATED in narrow-angle glaucoma, severe ulcerative colitis, and urinary retention; caution in older patients because of cognitive/fall risk.", "The indication comes from the condition's own article, which lists the antimuscarinics for urge incontinence - oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine and trospium. The dose comes from the Vesicare label.", "THIS CARD IS NOT THE WHOLE PICTURE. Its article also sets out the drugs for STRESS incontinence - \"Alpha-adrenergic agonists, such as phenylpropanolamine; duloxetine (not FDA-approved; imipramine; vaginal estrogen cream; and overactive bladder pharmaceutical agents as appropriate.\" - and those drugs live on the separate STRESS URINARY INCONTINENCE card, which carries duloxetine and vaginal estriol. Establish which type it is first: an antimuscarinic does nothing for pure stress incontinence." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in children have not yet been established. Vesicare should not be used 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": "NANOFREQ 5 MG 20 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 37.25, "pack_count": 20, "unit_price": 1.86, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IMPRONACIN 5MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 25.2, "pack_count": 10, "unit_price": 2.52, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "URGINAFECT 5 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 72.0, "pack_count": 20, "unit_price": 3.6, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SLOWURGE 5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > BIOMED", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOLITRACT 5 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 117.0, "pack_count": 30, "unit_price": 3.9, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TORMEEL 5 MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 126.0, "pack_count": 30, "unit_price": 4.2, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOFENACIN 5MG 30 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 141.0, "pack_count": 30, "unit_price": 4.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VESICARE 5 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTELLAS PHARMA > AKHNATON TRADING & DISTRIBUTION", "price_egp": 377.0, "pack_count": 30, "unit_price": 12.57, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOFENACIN 1MG/ML ORAL SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 88.0, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "URGINAFECT 1MG/ML ORAL SUSP. 150 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 88.0, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "urinary-incontinence" }, { "id": 1813, "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": "Urinary Incontinence - disease-level clinical article (urinary-incontinence-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Overflow incontinence is the only type that is directly physically dangerous (can cause renal failure and permanent bladder damage) - an antimuscarinic such as solifenacin would not treat this and could worsen retention.", "RED FLAG - The criteria for further evaluation or specialist referral are relapse, recurrent UTI, new-onset neurologic symptoms, marked prostate enlargement, neurogenic bladder, pelvic organ prolapse past the introitus, pelvic pain, persistent or unexplained hematuria, persistent proteinuria, post-void residual >200 mL, previous pelvic surgery or radiation, spinal cord injury, surgical complication, treatment failure, or uncertain diagnosis." ], "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" }, { "id": 1814, "generic": "Bethanechol", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "10 to 50 mg by mouth three or four times a day, found by titration from a small test dose. US label verbatim: \"The usual adult oral dose ranges from 10 to 50 mg three or four times a day. The minimum effective dose is determined by giving 5 to 10 mg initially, and repeating the same amount at hourly intervals until satisfactory response occurs, or until a maximum of 50 mg has been given.\" Give it on an empty stomach - \"Preferably give the drug when the stomach is empty. If taken soon after eating, nausea and vomiting may occur.\"", "adult_duration": "Short and conditional: continued use depends on whether residual volumes actually fall. The label notes the effect is brief, lasting only about an hour.", "dose_source": "BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81)", "rationale": "Two documents, and the gap between them is stated rather than hidden. The disease article names bethanechol - a detrusor stimulant - for this subtype, overflow urinary incontinence, alongside the alpha-adrenergic antagonists doxazosin, terazosin and tamsulosin. The US label never uses the word incontinence; its indication covers the underlying state instead: retention that is acute, nonobstructive and functional, following surgery or childbirth, and neurogenic atony of the bladder where retention persists. That underlying mechanism is what the article is drawing on, and the dose given here is the label's. Egypt registers no bethanechol product of any kind, so no brand or price can be shown.", "cautions": [ "RED FLAG - never give it when the bladder cannot empty because something is blocking it. Label verbatim: \"Bethanechol chloride should not be employed when the strength or integrity of the gastrointestinal or bladder wall is in question, or in the presence of mechanical obstruction\". Obstruction is excluded first; a catheter and a urology referral, not a detrusor stimulant.", "Contraindicated in a long list of ordinary comorbidities. Label verbatim: \"Hypersensitivity to bethanechol chloride, hyperthyroidism, peptic ulcer, latent or active bronchial asthma, pronounced bradycardia or hypotension, vasomotor instability, coronary artery disease, epilepsy and parkinsonism.\"", "Cholinergic overdose has an antidote to hand. Label verbatim: \"If necessary, the effects of the drug can be abolished promptly by atropine\".", "A high post-void residual with overflow leakage is measured, not guessed - and the article's own conservative arm is clean intermittent catheterisation, an indwelling urethral catheter, and relieving the obstruction." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose is stated in the label used here. Overflow incontinence in a child means an anatomical or neurological cause until proven otherwise and belongs with paediatric urology.", "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" } ] }