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Can Deneuron be taken to manage stress incontinence?

Q: I have severe stress and urge incontinence (continuous discharge) and have been advised surgery, which I wish to avoid. Is it possible? Meanwhile the gynaecologist has prescribed Deneuron (20 mg) (Duloxetine & Methylcobalamin) twice a day to control the urges through the nervous system. I find it helpful; I have been taking the medicine for the last 10 days. I am under medication for hypertension and type 2 diabetes. What are the risks associated with the intake of the drug prescribed? I feel very sleepy after taking the medicine.

A:The management of Stress Urinary Incontinence (SUI) or Urge Urinary Incontinence (UUI) or Mixed Urinary Incontinence (MUI) involves several measures including management of fluid balance, weight loss in the obese, appropriate exercise and stopping smoking (if applicable) in addition to drug therapy. Some intra-vaginal devices can also help in addition to biofeedback by using perineometer. Duloxetine (sold as Delok) is an antidepressant agent. Some clinical trials have shown that about half the patients of SUI get some benefit when they take this drug. However, this drug is not approved by any regulatory authority (such as US Food and Drug Administration, British MHRA, Australian TGA etc) for the treatment of SUI. Its side effects include: GI upset, dry mouth, sleepiness, dizziness, tremor, blurred vision, hot flushes, increased sweating, fatigue, liver injury, syncope and generalised anxiety disorder. There is no evidence that combining duloxetine with methylcobalamin has any utility. Such a combination is not permitted in any advanced country and is irrational. The conventional drug therapy for SUI is either oxybutynin or tolterodine (Detrusitol). Your blood pressure therapy needs to be reviewed. Diabetics should not take Atenolol since it makes the disorder worse. The first line therapy in such cases should invariably be enalapril (sold as BQL, Enam, etc) 5-10mg 1-2 times daily. Apart from controlling blood pressure, the drug also protects the kidneys, which normally suffer due to high blood sugar. You also need to reduce your weight since it will help in all the three problems: SUI, high blood pressure and diabetes.

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