Off-label incontinence treatment does more harm than good

The antidepressant duloxetine should not be used off-label to treat female stress incontinence, a meta-analysis shows.

Although use of the drug led to a 14% decrease in episodes of stress incontinence and an increase from 64 to 67 on an incontinence quality-of-life score, these were small effects outweighed by the harms caused, researchers said.

The study comparing 958 women with stress incontinence taking 80mg duloxetine daily with a similar number on placebo was led by Dr Peter Götzche, the Cochrane collaboration co-founder famous for his contentious views on breast screening. 

The analysis showed eight women needed to take the drug for one to experience a benefit, but the number needed to harm was seven for events such as hostility, anxiety, restlessness or shakiness, the authors wrote in the CMAJ.

And women taking the drug were five times more likely to pull out of the trial because of

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