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Is Increased Vesigard Dosage Required For Urinary Incontinence?

Posted on Wed, 7 May 2014

Question: Hello Dr.Sasanka, Here's the results for serum creatinine and urine culture: https://www.dropbox.com/s/h7cyvyy8d09omg8/shilpa_reports_0000.zip The total water intake is between 1000 - 1500 ml per day excluding food sources and not more than 150 ml per hour. It certainly helped a little bit with the incontinence during the day but not too much. The amount of urine during CISC (and bladdder capacity) seem increased though, 200 every 2 hours, but this is not persistent (sometimes there's more frequent incontinence and need for CISC) At night the incontinence increases. All water intake is stopped at around 10:00 PM (dinner). Still, there is frequent need for CISC (every hour or two) and incontinence during night , which continues till 6-7 AM in the morning. Currently she is on Vesigard 7.5 mg and Nitrofurontoin 100 mg both taken at dinner, around 9.30 PM. Do we need to increase vesigard dosage ? Do wen need to stop Nitrofurontoin ? (earlier it was 200mg per day. We've reduced it to 100mg) Please suggest the next steps.

Answered by Dr. V. Sasanka (5 hours later)

Brief Answer: We increase dosage and see how things work Detailed Answer: Hi again, Looks like things are not too bad in the sense the Creatinine value is good, and culture report has come sterile, and she does not seem to have suffered from fever (otherwise you would have mentioned it) There is now a definite case for increasing the dose of Vesigard. We can try and see how things work if she starts taking 15 mg per day at bedtime. She might experience dry mouth, and I suggest she take enough water to satisfy her dry mouth, but not so much that water intake will cause increased urine output and increased frequency of incontinence episodes. If incontinence is persisting despite treatment with maximal dosage of Vesigard, we can think of other measures.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. V. Sasanka (1 hour later)

Thanks, we'll start the increased dosage for Vesigard. Taking water at night (after 10PM) is almost impossible as it is already causing incontinence, we've tested this. Just for my understanding, why take 15mg once at bed time and not 7.5 twice (lunch & dinner), as in the later case we can manage dry mouth much better (day time). Also, we need to continue Nitrofurontoin 100mg correct ?

Answered by Dr. V. Sasanka (53 minutes later)

Brief Answer: 15mg once a day works better Detailed Answer: The drug is formulated in a way where it works for 24 hours. So it does not help if you take 7.5mg twice a day. The nitrofurantoin cab be continued for the present at the same dosage as it seems to have prevented a serious infection Let me know the progress. Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar