Oxybutynin (Oral)

Overview

Oxybutynin was first approved for the treatment of urinary incontinence and bladder control issues in 1975. Oxybutynin improves bladder control by relaxing the smooth muscles of the bladder. It does this by directly reducing the involuntary spasm of the bladder muscles and also inhibits the effects of acetylcholine on the muscle. Thus the medication functions as both an anticholinergic and an antispasmodic.

Oxybutynin is used to treat a variety of conditions around incontinence. It is prescribed for adult patients suffering from the overactive bladder as well as those suffering from frequent or urgent urination needs. It is also prescribed for people with bladder leakage.

It is also prescribed for pediatric patients who struggle with enuresis, particularly for those with neurological conditions with detrusor overactivity, such as spina bifida.

Oxybutynin is contraindicated in patients with uncontrolled narrow-angle glaucoma.

It is generally not recommended for patients with myasthenia gravis, Parkinson's disease, preexisting dementia, or autonomic neuropathy. This medication is metabolized mainly in the liver, so patients with hepatic dysfunction should take oxybutynin with caution.

Oxybutynin is also not recommended for patients with digestive disorders such as ulcerative colitis or gastroenteritis, as well as any other sort of gastric or urinary retention issues. These conditions can be exacerbated and symptoms aggravated by the effects of this medication. If patients are prescribed oxybutynin, it should be done with caution and under medical supervision.

Oxybutynin is known to interact with many medications, has major interaction with over 80. It should not be given concomitantly with any other anticholinergic medication. It also interacts negatively with alcohol. Patients on oxybutynin should not ingest alcohol.

This medication carries the risk of many side effects. It can cause headaches and runny nose. It can also cause or worsen sexual dysfunction, including decreased libido and the inability to get or maintain an erection in males. Some of the more serious side effects include an irregular heartbeat, fainting and a host of digestive issues.

Oxybutynin has been known to cause an allergic reaction in patients with a hypersensitivity to its chemical components. This reaction may be quite serious, including edema, constriction of the throat and difficulty breathing. In cases of allergic reaction, the patient should seek immediate medical attention.

Oxybutynin is available in several different forms including regular tablet, extended release tablet, transdermal patch and transdermal gels. Most patients are prescribed this medication in tablet form to be taken orally. Doses should be taken at the same time every day with water. Patients should follow dosing instructions exactly as it is possible to overdose on oxybutynin.

Conditions Treated

  • Overactive bladder
  • Incontinence
  • Enuresis
  • Urgent urination
  • Bladder leakage

Type Of Medication

  • Anticholinergic
  • Antispasmodic

Side Effects

While clinically very effective in the treatment of bladder control issues and conditions, oxybutynin may also cause many different side effects in patients taking this medication. Some of the side effects are more inconvenient than dangerous and do not require medical attention. There are also steps patients may take to reduce the severity of these symptoms. Patients may experience one or more of the following symptoms:

  • Runny nose
  • Dry mouth
  • Diarrhea
  • Upset stomach
  • Constipation
  • Abdominal pain and increased belching
  • Indigestion
  • Dry eyes

The following side effects are less common, but not necessarily dangerous:

  • Insomnia or difficulty falling asleep
  • Decreased production of breast milk
  • Headache
  • Nausea
  • Increased fatigue
  • Feelings of weakness
  • Blurry vision
  • Difficulty swallowing
  • Feeling flush
  • Decreased libido

The following side effects are rare but have been reported. These side effects may require discontinuation of oxybutynin. If a patient experiences any of the following, he or she should call their physician:

  • Tingling in the feet or hands
  • Unusual changes in weight either gain or loss
  • Erectile dysfunction
  • Edema in the lower legs or feet
  • Swelling of the hands or face

Allergic reaction to this medication is possible. If a patient experiences any of the following, he or she should seek immediate medical attention:

  • Hives
  • Swelling of the mouth, face, tongue or throat
  • Skin rash
  • Severe pain in the eyes

It is possible to overdose on oxybutynin. If overdose is suspected, contact poison control and call 911 immediately. The symptoms of overdose include one or more of the following:

  • Heart arrhythmia (rapid or slow)
  • Seizure
  • Difficulty breathing
  • Fever
  • Dizziness and vertigo symptoms
  • Syncope
  • Hallucinations
  • Rapid and unusual mood changes including increased irritability
  • Loss of balance and motor control

Dosage

Oxybutynin is available in several different forms of delivery and strengths of dose. Patients may be prescribed this medication in tablet form, syrup or as a transdermal gel or patch. Dosing requirements adjust based on the method of delivery and the age of the patient, as well as any other extenuating circumstance such as another medical condition.

For adults being treated for urinary incontinence because of overactive bladder. bladder leakage or urinary frequency, the usual dose is as follows:

Regular tablets or syrup solution: 5 mg taken orally two to three times daily, maximum dose is 20 mg a day

Extended-release tablets: 5 mg to 10 mg once daily (to be taken at the same time every day). Dosing may adjust upward with maximum dosage being 30 mg a day

Any tablet should be taken with water and swallowed whole. Patients should not crush or chew up the tablet.

Transdermal patch: 3.9 mg daily applied directly to dry skin on the hip, buttock or lower abdomen. A new patch should be applied twice a week, avoid the same application site for at least seven days.

Transdermal Gel (10% solution): this form comes in sachets. The gel should be applied once daily to dry skin on the upper arms, thighs, shoulders or abdomen. Patients should rotate application areas to reduce the risk of skin reactions.

Transdermal Gel (3% solution): 84 mg applied once daily to dry skin on upper arms, thighs, shoulders or abdomen. Patients should rotate application area to reduce the risk of skin reaction.

Patches and gel should be applied immediately after removing the medication from the container or packaging.

Dosing instructions for geriatric patients are as follows:

Regular tablets or syrup solution: 5 mg taken orally twice daily, maximum dose is 15 mg per day

Extended-release tablets: 5 mg taken orally once daily, may adjust upward to a maximum dose of 15 mg daily

For pediatric patients being treated for enuresis or incontinence, the usual dosing is as follows:

Regular tablets or syrup solution: 5 mg taken orally twice daily, maximum dose is 15 mg per day

Extended-release tablets (for patients over 6 years): 5 mg taken once daily, may adjust to 15 mg per day

This medication should be taken with water and at the same time every day. If the patient misses a dose, he or she should wait to take the medication until the next normal dosing time. For patients who suffer from impaired renal or hepatic function, oxybutynin should be taken with caution. The maximum dose should not be exceeded and dosing may need to be adjusted downward if kidney or liver function worsens.

Interactions

Oxybutynin interacts with over 640 other medications that treat a variety of conditions. Major drug interaction with this medication include:

  • Bisacodyl
  • Citric acid
  • Potassium chloride
  • Lidocaine
  • Phentermine
  • Potassium citrate
  • Potassium acetate
  • Topiramate
  • Zonisamide

Oxybutynin may possibly be used concomitantly with the following medicines, as the interactions between them is more moderate. However, physicians should certainly be aware that patients are taking both medications and use caution when prescribing one or the other:

  • AbobotulimumtoxinA
  • Acetaminophen and pseudoephedrine
  • Acebutolol
  • Aliskiren
  • Pentazocine
  • Acetaminophen and caffeine and dihydrocodeine
  • Aspirin
  • Chlorpheniramine
  • Amiloride
  • Pyrilamine
  • Phenyltoloxamine
  • Aclidinium
  • Amlodipine and olmesartan
  • Albuterol
  • Triprolidine
  • Acrivastine
  • Aluminum hydroxide
  • Ambenonium
  • Dextromethorphan
  • Amoxapine
  • Amitriptyline
  • Amylase and cellulose
  • Amantadine
  • Hyoscyamine
  • Aripiprazole
  • Anhydrous calcium iodide
  • Asenapine
  • Arbutamine
  • Atropine
  • Scopolamine
  • Atenolol
  • Azatadine
  • Benztropine
  • Bisoprolol
  • Belladonna
  • Boceprevir
  • Botulinum toxin type b
  • Betaxolol
  • Butorphenol
  • Fentanyl
  • Brigatinib
  • Bosentan
  • Buprenorphine
  • Brexpiprazole
  • Bethanechol
  • Hydrocodone
  • Bexarotene
  • Guaifenesin
  • Biperiden
  • Carbachol ophthalmic
  • Sodium salicylate
  • Carbetapentane
  • Levodopa
  • Carvedilol
  • Carbidopa
  • Phenylephrine
  • Cariprazine
  • Ibuprofen
  • Carteolol
  • Chlophedianol
  • Clozapine
  • Chlorcyclizine
  • Dexchlorpheniramine
  • Clemastine
  • Cobicistat and darunavir
  • Codeine
  • Conivaptan
  • Cyclobenzaprine
  • Cyproheptadine
  • Dezocine
  • Dabrafenib
  • Dicyclomine
  • Darifenacin
  • Dexbrompheniramine
  • Dasatinib
  • Dimenhydrinate
  • Demecarium bromide (ophthalmic)
  • Naproxen
  • Deferasirox
  • Droperidol
  • Donepezil
  • Doxylamine and puridoxine
  • Disopyramide
  • Doxepin (topical)
  • Dronedarone
  • Echothiophate iodide (ophthalmic)
  • Etravirine
  • Eluxadoline
  • Edrophonium
  • Ethanol
  • Theophylline
  • Efavirenz
  • Enzalutamide
  • Ropivacaine
  • Fosaprepitant
  • Fesoterodine
  • Formoterol
  • Fluticasone
  • Flavoxate
  • Fluoxetine
  • Glycopyrrolate
  • Fluphenazine
  • Vilanterol
  • Olanzapine
  • Ggalantamine
  • Hydromorphone
  • Indacaterol
  • Guanidine
  • Homatropine
  • Phenobarbital
  • Haloperidol
  • Methenamine
  • Metoprolol
  • Methylene blue
  • Oxycodone
  • Phenyl salicylate
  • Idelalisib
  • Incobotulinumtoxin-A
  • Iloperidone
  • Ipratropium
  • Imipramine
  • Isoflurophate (ophthalmic)
  • Isoprotenerol
  • Isavuconazonium
  • Labetaolo
  • Ketoconazole
  • Levomethadyl acetate
  • Lactobacillus acidophilus
  • Loxapine
  • Lapatinib
  • Simethicone
  • Levorphanol
  • Ribociclib
  • Loperamide
  • Letermovir
  • Lurasidone
  • Maprotiline
  • Morphine
  • Meclizine
  • Mirabegron
  • Methdilazine
  • Metoclopramide
  • Naltrexone
  • Mepenzolate
  • Mifepristone
  • Beperidine
  • Mibefradil
  • Nadolo
  • Nilotinib
  • Nalbuphine
  • Nebivolol and valsartan
  • Nortriptyline
  • Naloxone
  • Neostigmine
  • Palonosetron
  • Olodaterol
  • Opium
  • Oxcarbazepine
  • OnobotulinumtoxinA
  • Orphendrine
  • Paliperidone
  • Pindolol
  • Penbutolol
  • Procyclidine
  • Physostigmine
  • Pramlintide
  • Pilocarpine
  • Propiomazine
  • Pyridostigmine
  • Pimozide
  • Propoxyphene
  • Quetiapine
  • Solifenacin
  • Tacrine
  • Trospium
  • Telaprevir
  • Tripelennamine
  • Telithromycin
  • Trihexyphenidyl
  • Telotristat
  • Tolterodine
  • Thioridazine
  • Trigluoperazine
  • Thiothixene
  • Tiotropium
  • Umeclidinium
  • Ziprasidone

Oxybutynin has minor interactions with some other medications, but these interactions are typically not dangerous. As long as the physician and patient are comfortable with taking both medications, there would generally be no reason to avoid it.

Warnings

Patients who suffer from uncontrolled narrow-angle glaucoma should not use oxybutynin as it may worsen the condition.

For patients with myasthenia gravis, oxybutynin should only be prescribed with caution and frequent monitoring as this medication may aggravate symptoms and further weaken muscles.

This is also true for patients being treated for Parkinson's disease. Oxybutynin may further exacerbate the loss of motor control and interact negatively with medications used to treat Parkinson's.

Oxybutynin is not recommended for patients who suffer from pre-existing dementia as it interacts negatively with medications that are used in its treatment.

Because it impacts gastrointestinal motility rates, patients who also have gastroenteritis, ulcerative colitis or other serious digestive disorders should take Oxybutynin with great caution. It may worsen their condition.

For patients with a bacterial infection that is causing severe diarrhea, oxybutynin is not recommended as it may extend the length of the infection by preventing the excretion of the bacteria.

Any patient who has issues with urine retention and completely emptying the bladder, particularly if there is some sort of blockage should only take this medication if the physician feels the benefits outweigh the potential risks.

This is also true for patients with gastric retention or any sort of gastric or intestinal blockage. Use of an antispasmodic medication may aggravate that condition.

Oxybutynin may aggravate symptoms and conditions related to autonomic neuropathy. These may include blurred vision, sexual dysfunction, tachycardia, and other serious issues. Patients suffering from autonomic neuropathy should only be administered this drug with great caution and out of real necessity. While not contraindicated, it is not a recommended treatment for these patients.

Because it can cause drowsiness and fatigue, patients taking oxybutynin should not ingest alcohol. The combination could lead to increased dizziness and drowsiness.

Patients who have been diagnosed with gastroesophageal reflux disease (GERD) may experience a worsening of their symptoms while taking oxybutynin.

Oxybutynin is metabolized almost entirely in the liver, so patients with hepatic impairment may take this medication, but liver function and enzyme levels should be frequently monitored to ensure the condition is not worsening.

Allergic reaction and hypersensitivity to oxybutynin has been reported. Patients who have experienced hypersensitive to other anticholinergic medications should not take oxybutynin.

Oxybutynin is classified as a category B medication for pregnant women. There is no data to indicate that this medication negatively impacts fertility or the fetus of a pregnant woman, but should only be prescribed if the potential benefits outweigh potential risks.

Caution should also be used when prescribing this medication to a nursing mother.

Oxybutynin has been safely tested for use with patients above the age of five. It has not been tested and is not recommended for children under the age of five. It can be used safely in geriatric patients as well as long as they do not have other diseases or conditions that might prevent its use.

There is no indication that race has any impact on the efficacy of oxybutynin.

Oxybutynin may be used safely over extended periods of time as long as other body systems are not being negatively affected. Prolonged use does increase the risk of urinary tract infection in some patients.

Oxybutynin is absorbed at the same rate and safely whether the patient takes it with food or on an empty stomach. However, it should be taken with water.

Because oxybutynin can decrease sweating in some patients, its use may lead to increased risk of heat stroke and prostration. Patients should be advised of this risk.

Oxybutynin tablets should be swallowed whole. They should not be chewed, divided or crushed. This is particularly true of the extended-release form of the tablet as that would release too much medication into the body at one time.

This medication should be taken at the same time every day.

Storage

Oxybutynin in any of its forms does not require refrigeration. The tablets come in bottles of 100 tablets, 500 tablets or 1000 tablets. Tablets should be kept in the original container until consumed. The pills should be dispensed in tightly sealed containers that are light resistant. The medication should be stored at room temperature and kept safely out of the reach of children or animals. Since overdose is possible, precautions should be taken to make sure oxybutynin is not accidentally available. Unused medication should be disposed of safely. Patients should consult with their doctors or pharmacists about the best method for disposing of medicines. A drug take-back program is the best option for getting rid of any prescription medication.

Summary

As an anticholinergic and an antispasmodic drug, oxybutynin is prescribed to improve a patient's control over bladder function. It functions by preventing the action of acetylcholine on the smooth muscle of the bladder that causes nerve impulses that create muscle constriction in the bladder. It also relaxes the muscles of the bladder which helps prevent urine retention and helps the bladder empty more thoroughly thus reducing some of the frequency of the need to urinate.

This medication may be taken by adults and children over the age of six. It is used to treat overactive bladder, enuresis, frequent and urgent urination and bladder leakage. It should not be prescribed to patients who have uncontrolled narrow-angle glaucoma or patients who suffer from either gastric or urinary retention issues, particularly if there is some gastric or intestinal blockage. Oxybutynin may aggravate the symptoms associated with these conditions and interact negatively with the medication prescribed to treat them. It also interacts negatively with medications prescribed for Parkinson's, digestive disorders and dementia.

The medication is usually prescribed in tablet form, either for immediate or extended release, although it is also available in gel form or as a transdermal patch. It is important that oxybutynin be taken at the same time daily with water. It may be taken with or without food.