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. 2023 Nov 28;20:100330. doi: 10.1016/j.lansea.2023.100330

Table 1.

Fact sheet of lacunas/points of incoordination between WHO/UMC/AUA/EAU/AGS.

S. No Drugs/drug classes/combinations STOPP/START criteria Beers criteria 2019 AUA guideline EAU guidelines
1. Antimicrobial drugs (Nitrofurantoin, Trimethoprim-Sulfamethoxazole) Silent Avoid in individuals with Creatinine clearance <30 ml/min
  • a)

    First line treatment for uncomplicated UTIs

  • b)

    Avoid in patients with chronic lung disease and for long term use
  • a)

    First line antibiotic for Acute UTIs, but potential serious risk of pulmonary and hepatic toxicity

  • b)

    Avoid if GFR <30 ml/min
2. Drugs for ED
Phosphodiesterase type-5 inhibitors (Sildenafil, Tadalafil, Vardenafil, Avanafil)		 Avoid in severe heart failure characterized by hypotension i.e. systolic BP <90 mmHg, or concurrent daily nitrate therapy for angina (risk of cardiovascular collapse) Silent Avoid Phosphodiesterase type-5 inhibitors in combination with nitrate containing medication
  • a)

    Absolute contraindication with organic nitrates or NO donors

  • b)

    Use with caution in combination with anti-hypertensive drugs like calcium channel blockers, beta blockers and diuretics etc.
3. Loop diuretic (Frusemide, Torsemide) Avoid loop diuretics for the treatment of hypertension with concurrent urinary incontinence (may exacerbate incontinence) Avoid combination of Peripheral alpha 1 blockers with loop diuretics Silent Silent
4. Selective alpha 1 blockers (Alfuzosin, Doxazosin, Prazosin, Tamsulosin, Terazosin, Silodosin) Avoid in persons with symptomatic orthostatic hypotension/micturition syncope Avoid in combination with loop diuretics in older women (Increased risk of urinary incontinence) Silent First line treatment in men with LUTD
5. Drugs with anticholinergic properties
I. Anti-muscarinic drugs (Oxybutynin, Tolterodine, Propiverine, Solifenacin, Darifenacin, Trospium, Fesoterodine
  • a)

    Avoid concomitant use of two or more drugs with such properties

  • b)

    Avoid in persons with chronic constipation

  • c)

    Avoid in overactive patients with dementia, narrow angle glaucoma, chronic prostatism

 Avoid except anti-muscarinics for urinary incontinence
  • a)

    Use with caution in patients using other medications with anti-cholinergic properties

  • b)

    Use with caution in frail OAB patients
  • a)

    Avoid if post void urine >150 ml

  • b)

    Prescribe with caution in older adults
II. Tricyclic antidepressants with anticholinergic properties (Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Paroxetine, Protriptyline, Trimipramine Avoid TCAs with dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, or prior history of urinary retention (risk of worsening these conditions) Avoid (Because of anticholinergic side effects and orthostatic hypotension) Silent Silent
III. Neuroleptics with moderate-marked antimuscarinic/anticholinergic effects (Chlorpromazine, Clozapine, Lupenthixol, Fluphenzine, Pipothiazine, Promazine, Zuclopenthixol STOPP Avoid in patients with a history of prostatism or previous urinary retention (high risk of urinary retention) Silent Silent
IV. Anti-muscarinic bronchodilators (Ipratropium, Tiotropium) STOPP in patients with a history of narrow angle glaucoma (may exacerbate glaucoma) or bladder outflow obstruction (may cause urinary retention) Silent Silent Silent
V. First generation antihistamines (constituent of OTC cough syrup preparations) in older people who are suffering from BPH (potential of precipitating acute retention of urine) (Brompheniramine, Carbinoxamine, Chlorpheniramine, Clemastine, Cyproheptadine, Dexbrompheniramin, Dexchlorpheniramin, Dimenhydrinate, Diphenhydramine (oral), Doxylamine, Hydroxyzine, Meclizine, Promethazine, Pyrilamine, Triprolidine) Silent Silent Silent Silent
6. Desmopressin/DDAVP Silent Avoid for the treatment of nocturia and nocturnal polyuria (High risk of hyponatremia) Silent
  • a)

    <65 year older adults: start with low dose (0.1 mg/day) and gradually increased upto 0.4 mg/day

  • b)

    >65 year patients: low dose may be prescribed, avoid if serum sodium levels below normal

  • c)

    >75 year patients: should be used with caution as increased risk of hyponatremia
7. Androgens
Methyltestosterone
Testosterone		 Avoid in absence of primary or secondary hypogonadism (Risk of androgen toxicity) Avoid unless indicated for confirmed hypogonadism with clinical symptoms Avoid unless there is confirmed hypogonadism (<300 ng/ml)
  • a)

    Avoid in absence of symptomatic hypogonadism

  • b)

    Absolutely contraindicated in untreated breast and prostate cancer

  • c)

    Relative contraindication in poorly controlled CHF, acute CVS events, Severe LUTS
8. Complementary and Alternative Medicine Silent Silent Silent Recommends Hexane extracted Serenoa repens to men with LUTS who want to avoid potential adverse effects related to sexual function