oxybutynin (Ditropan, Oxytrol, Gelnique)
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Introduction
Tradenames: Ditropan, Oxytrol.
Indications
- urge incontinence
- aspasmodic agent for neurogenic bladder
- hyperhidrosis[13]
Contraindications
- ulcerative colitis
- not useful in older cognitively impaired nursing home patients[12]
Dosage
Tabs: 5 mg.
TransDermal oxybutynin: <Oxytrol>[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: <Gelnique> 1 g packet QD[8]
Adverse effects
- common (> 10%)
- drowsiness, dry mouth, decreased sweating, constipation
- adverse effects may be least with Oxytrol transdermal[6]
- 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
- uncommon (< 1%)
- other[2]
- cycloplegia
- hallucinations[7]
- confusion & sedation in the elderly[7]
- 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
- oxybutynin increases
- bioavailability of atenolol
- serum levels of digoxin
- oxybutynin decreases
- L-dopa activity
- antipsychotic effects of haloperidol
- amantadine in combination increases anticholinergic effects
- transdermal patch (Oxytrol) has less anticholinergic effects[5]
Mechanism of action
- direct antispasmodic effect on smooth muscle
- inhibits muscarinic action of acetylcholine on smooth muscle
- primarily muscarinic M3 receptor antagonist[6]
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ 2.0 2.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 Journal Watch 21(10):82, 2001 Appell et al May Clin Proc 76:358, 2001
- ↑ 5.0 5.1 5.2 Prescriber's Letter 10(4):20 2003
- ↑ 6.0 6.1 6.2 Prescriber's Letter 12(2): 2005 Antimuscarinic Medications for Overactive Bladder Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210209&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 7.2 Prescriber's Letter 14(5): 2007 Stronger Warnings About Oxybutynin Side Effects Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230522&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 Prescriber's Letter 16(6): 2009 Antimuscarinic Medications for Overactive Bladder Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250611&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 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
- ↑ Deprecated Reference
- ↑ 11.0 11.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21710237
- ↑ 12.0 12.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21450183
- ↑ 13.0 13.1 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26114588 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/bjd.13973/abstract;jsessionid=C385BA5DB2646E4474E4D2E6A846BDCB.f04t03