Statement on Aquiette Proposal by Dr Julian Spinks
My name is Dr Julian Spinks and I am a general practitioner with a specialist interest in the management of incontinence.
The proposal to make low-dose oxybutynin (Aquiette) available through pharmacies needs to be viewed against a background of the large number of women who suffer from urinary incontinence caused by overactive bladder. Despite the increasing visibility of incontinence products in adverts, incontinence continues to be a condition which is associated with significant embarrassment and stigma. This often leads to long delays before women seek help from healthcare professionals. These women miss out on early opportunities to treat the underlying cause of their incontinence, such as overactive bladder.
Widening the availability of treatment with low-dose oxybutynin through pharmacies offers women with the early stages of overactive bladder an additional way to receive the help they need if they do not wish to consult their GP or a continence service.
Oxybutynin is already widely in use as a prescription-only treatment for overactive bladder and, together with other anticholinergic bladder drugs, remains recommended by NICE as a first-line prescribed pharmacological treatment for overactive bladder following bladder training (Bladder training is a way of teaching the bladder to hold more urine and helps to reduce the number of times a person needs to pass urine and to reduce incontinence)
Long-term use Oxybutynin is not suitable for some women, particularly older women who are at a greater risk of physical or mental decline and NICE recommends it is not used in this group. The current proposal is for short-term (12 weeks maximum), low-dose, oxybutynin in 18 to 65 year-olds. This would only be offered after a pharmacist has assessed to ensure it is appropriate to use in the individual. The dose and duration proposed are highly unlikely to present the same concerns than long term use of higher-dose anticholinergic medications on prescription.
The oxybutynin is being offered together with bladder training. This offers an opportunity for the woman to reduce the progression of her overactive bladder and should diminish the need for ongoing pharmacological treatment at the end of the course. An additional proposed protection is that those women who continue to have problems will be advised to seek advice from their doctor or from a continence service.
Given the large numbers of women who do not seek help but continue to suffer from urinary incontinence due to overactive bladder, I view the availability of low-dose oxybutynin through pharmacies to be an extremely positive development and an important way to improve women’s health.