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oxybutynin (Ditropan, Oxytrol, Gelnique)

Tradenames: Ditropan, Oxytrol. Indications: - urge incontinence - urinary frequency - urinary urgency - detrussor instability - aspasmodic agent for neurogenic bladder - hyperhidrosis [13] Contraindications: - ulcerative colitis - not useful in older cognitively impaired nursing home patients [12] Dosage: 1) 5 mg PO BID-QID 2) max: 5 mg QID (20 mg/day) Tabs: 5 mg. Elixir: 5 mg/5 mL. Ditropan XL: 10 mg PO QD [4] TransDermal oxybutynin: [5] - twice a week or every 4 days - rotate site (hip, abdomen, buttocks) - delivers 3.9 mg/day ox oxybutynin - now OTC [9] for women >= 18 years of age - by prescription only for men [9] TransDermal oxybutynin gel: 1 g packet QD [8] Adverse effects: 1) common (> 10%) - drowsiness, dry mouth, decreased sweating, constipation - adverse effects may be least with Oxytrol transdermal [6] 2) less common (1-10%) - hot flashes, tachycardia, palpitations, weakness, dizziness, insomnia, fever, rash, nausea/vomiting, blurred vision, urinary hesitancy or retention*, decreased flow of breast milk, sexual dysfunction, headache, mydriasis 3) uncommon (< 1%) - increased intraocular pressure, allergic reaction 4) other [2] 1) cycloplegia 2) hallucinations [7] 3) confusion & sedation in the elderly [7] 4) higher rate of discontinuation the tolterodine [11]; mean 68 days vs 128 days * urinary hesitancy or retention may be especially significant in men with prostatic hypertrophy (BPH) Drug interactions: 1) oxybutynin increases a) bioavailability of atenolol b) serum levels of digoxin 2) oxybutynin decreases a) L-dopa activity b) antipsychotic effects of haloperidol 3) amantadine in combination increases anticholinergic effects 4) transdermal patch (Oxytrol) has less anticholinergic effects [5] Mechanism of action: 1) direct antispasmodic effect on smooth muscle 2) inhibits muscarinic action of acetylcholine on smooth muscle 3) primarily muscarinic M3 receptor antagonist [6]

Interactions

drug interactions drug adverse effects of parasympatholytics

General

urinary antispasmodic

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category B safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Journal Watch 21(10):82, 2001 Appell et al May Clin Proc 76:358, 2001
  5. Prescriber's Letter 10(4):20 2003
  6. Prescriber's Letter 12(2): 2005 Antimuscarinic Medications for Overactive Bladder Detail-Document#: 210209 (subscription needed) http://www.prescribersletter.com
  7. Prescriber's Letter 14(5): 2007 Stronger Warnings About Oxybutynin Side Effects Detail-Document#: 230522 (subscription needed) http://www.prescribersletter.com
  8. Prescriber's Letter 16(6): 2009 Antimuscarinic Medications for Overactive Bladder Detail-Document#: 250611 (subscription needed) http://www.prescribersletter.com
  9. FDA News Release: Jan. 25, 2013 FDA approves over-the-counter Oxytrol for Women to treat overactive bladder http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336815.htm
  10. Deprecated Reference
  11. Gomes T1, Juurlink DN, Mamdani MM. Comparative adherence to oxybutynin or tolterodine among older patients. Eur J Clin Pharmacol. 2012 Jan;68(1):97-9. PMID: 21710237
  12. Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Efficacy of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence: a randomized placebo-controlled trial. J Am Med Dir Assoc. 2011 Nov;12(9):639-47 PMID: 21450183
  13. Schollhammer M, Brenaut E, Menard-Andivot N et al. Oxybutynin as a treatment for generalized hyperhidrosis: A randomized, placebo-controlled trial. Br J Dermatol 2015 Nov; 173:1163. PMID: 26114588 http://onlinelibrary.wiley.com/doi/10.1111/bjd.13973/abstract;jsessionid=C385BA5DB2646E4474E4D2E6A846BDCB.f04t03