Article

Oxybutynin (Ditropan; Ditropan XL; Gelnique; Anturol; Oxytrol)
January 30, 20190799

Oxybutynin is an anticholinergic drug used for the treatment of Overactive Bladder (OAB), hyperhidrosis and several other conditions.  It is available in multiple forms and brand names.  Oxybutynin is a very effective and popular form of treatment for these conditions, but has multiple side effects and precautions that need to be taken before being used.

 

Understanding Overactive Bladder and Anticholinergic Drugs

Do you find that you need to go to the bathroom more often than other people in your life?  If so, it is possible that you may have an OAB.2

OAB is a fairly common condition affecting around 33 million Americans.  According to the American Urological Association, “30 percent of men and 40 percent of women living in the United States live with OAB symptoms.”  This number could be much higher though, as many people are too embarrassed to ask for help.2

The most common symptoms of OAB include:

  • Needing to urinate often- more than eight times in 24 hours.
  • Leaking of urine- this can vary from a few drops to a sudden gushing.
  • Nocturia- waking up at night more than twice to urinate.
  • Painful urination.2-3,8

Besides these obvious physical symptoms, OAB can also affect many other areas of your life:

  • Limited social life due to the fear of needing to find a bathroom when out with friends.
  • Decreased quality of sleep leading to fatigue and depression.
  • Strained intimate relationship with your spouse or partner.
  • Added stress of suddenly needing the bathroom at work, even when busy with customers or colleagues.
  • Decreased ability to do physical exercise.
  • Skin problems due to frequent leaking of urine.2-3

If you have OAB, you are probably familiar with the above stresses far too well.  Fortunately, there are a number of different treatment options available.  These treatments can significantly improve your quality of life.  The most common treatment for OAB is the use of anticholinergic drugs.1,3,5-10,12-15

Anticholinergic drugs help to treat OAB by relaxing the muscles of the bladder. They do this by blocking the involuntary contractions of body muscles on a chemical level.1,3-10,12-15  This therefore reduces:

  • Leaking of urine between bathroom visits.
  • The sudden need to urinate.
  • How often you need the bathroom.1,3,5

 

What is Oxybutynin (DitropanDitropan XL; Gelnique; Anturol; Oxytrol)?

Oxybutynin is a medication that falls into the class of anticholinergic drugs.1,3,5-10,12-15  It cannot be purchased over the counter, so it needs to be prescribed by your doctor.10  There are a number of different forms available: oral syrup, immediate-release tablet, extended-release tablet, topical gel or skin patches.6,10

The most common brand-names for Oxybutynin are:

  • Ditropan (immediate-release tablet)
  • Ditropan XL (extended-release tablet)
  • Gelnique and Anturol (topical gels)
  • Oxytrol (skin patches).6,10

There are a number of generic versions of Oxybutynin available.6,10  Generic medications are cheaper and equally effective.  Ask your doctor or pharmacist for more information on these.

     

Oxybutynin Chloride tablet11

 

Uses of Oxybutynin

Oxybutynin can be used to treat a number of different medical conditions.  Examples of these conditions include:

  • Overactive bladder symptoms (as discussed already).
  • Spina bifida (in children and adults older than 6 years old) – a neurological birth defect where the spinal cord did not close properly.
  • Hyperhidrosis– a condition where excessive sweating is experienced.6

 

Oxybutynin for the Treatment of Hyperhidrosis

Hyperhidrosis is a fairly well-known condition where sweating is experienced in amounts much greater than what the body needs.4,16  The main concern with hyperhidrosis is how it affects quality of life.4,16

It can be caused as a side effect of medication or disease.16  Other causes include:

  • Diabetes Mellitus
  • Parkinson’s
  • Peripheral nerve injury
  • Hyper thyroidism
  • Hyperpituitarism
  • Spinal injury
  • Reflex sympathetic dystrophy
  • Respiratory diseases
  • Psychiatric diseases16

The most common body parts where the sweating is experienced are:

  • Armpits
  • Palms of hands
  • Soles of feet
  • Face16

Hyperhidrosis often starts to develop during childhood and can significantly decrease quality of life.  Most children who experience hyperhidrosis feel embarrassed about their condition and find it difficult to take part in normal day-to-day activities.4

There are several non-invasive treatments that can be used.  The most common form of treatment is using an anti-perspirant deodorant containing aluminium salts.  In the past, some tanning agents were found to effectively reduce sweating due to their astringent properties, but these are no longer used.16

Oxybutynin can also be used to treat hyperhidrosis.4,6,9,16  As mentioned earlier, Oxybutynin helps to relax the muscles in the bladder in the treatment of OAB.1,3,5-10,12-15  In the same way, it also helps to stop the sweat glands from releasing too much sweat by relaxing muscles in the sweat glands.4,16

Even though surgery is still the most effective treatment, Oxybutynin is a good, non-invasive alternative for reducing hyperhidrosis in the short- and long-term.4

 

Oxybutynin Dosage

It is very important to get a prescription from your doctor and to follow this prescription exactly.  This prescription will depend on your age, the reason you need to take Oxybutynin, how severe your condition is, and whether you have any other medical conditions or not.10

Here are some tips for taking Oxybutynin:

  • Try to take your prescribed doses at the same time each day.
  • Swallow the extended-release tablets whole with lots of water- do not crush or chew them. If you do crush or chew them, they will be absorbed quicker than they are meant to be.
  • Do not stop taking Oxybutynin without talking to your doctor first. Oxybutynin relieves symptoms, but doesn’t cure your condition.  You might feel better, but the condition is still there and the symptoms will return if you suddenly stop taking Oxybutynin.
  • Use a proper dose measuring spoon when taking Oxybutynin syrup- not a household teaspoon.
  • It can take about six to eight weeks for the full benefit of Oxybutynin to be experienced. Be patient, but if your symptoms do not improve after eight weeks, talk to your doctor.10

 

Adult Dosage

  • Syrup or immediate-release tablets: Five milligrams two to three times per day.  This may be increased by your doctor over time.6,10
  • Extended-release tablets: Five milligrams once per day.  This may be increased by your doctor up to 30 milligrams per day.6,10

 

Child Dosage (less than 18 years old)

  • Syrup or immediate release tablets: Five milligrams two to three times per day.  This may be increased up to 15 milligrams per day by your doctor.  Not recommended for children under 5 years old.6,10
  • Extended-release tablets: Five milligrams once per day.  This may be increased up to 20 milligrams by your doctor.  Not recommended for children under 6 years old.6,10

 

Oxybutynin Side Effects

While Oxybutynin is a very effective, non-invasive treatment for OAB and hyperhidrosis, its use is limited due to the side effects it often causes.  These side effects occur because Oxybutynin doesn’t only relax the muscles of the bladder and sweat glands, but also relaxes other muscles in the body.  This interferes with normal body functions.1,3,5-10,12-15

 

More Common Oxybutynin Side Effects

Some common side effects caused by taking Oxybutynin include:

  • Dry mouth, nose, eyes and skin.
  • Neurological side effects: headaches, drowsiness, dizziness, confusion, difficulty falling asleep and anxiety.
  • Gastro-intestinal side effects: constipation, diarrhea, nausea, gas and heart burn.
  • Swelling of limbs.
  • Taste changes.
  • Painful back or joints.6,`10

 

Serious Oxybutynin Side Effects

Even though less common, it is possible for more serious side effects to occur when taking oxybutynin.  If you begin to notice any of these, contact your doctor immediately or get to the nearest emergency room:

  • Fast, pounding or irregular heartbeat.
  • Breathing difficulties.
  • Difficulty swallowing.
  • Hives or rash on skin.
  • Swollen eyes, face, lips, tongue or throat.6,10

 

Warnings for Oxybutynin

There are certain precautions you should take before starting Oxybutynin treatment.  These should be discussed with your doctor before the medication is prescribed.6,10

 

General Warnings

  • Ask your doctor for a list of the ingredients and check if you are allergic to any of them. Mention any allergies you have.
  • Tell your doctor if you are planning to take any of the following while on Oxybutynin treatment:
    • Prescription medications.
    • Non-prescription medications.
    • Vitamin or nutritional supplements.
    • Herbal medications.
  • Let your doctor know if you have ever had any of the following conditions:
    • Any condition which has caused delayed or incomplete emptying of the stomach or bladder.
    • Narrow angle glaucoma- a very serious eye condition. Use of Oxybutynin could lead to loss of vision.
  • Let your doctor know if you currently have any of the following conditions:
    • Gastroesophageal reflux disease.
    •  
    • Heart, liver or kidney disease.
    • High blood pressure.
    • Ulcerative colitis.
    • Hiatal hernia.
    • Fast or irregular heartbeat.
    • Myasthenia gravis.
    • Benign prostatic hypertrophy.
  • It is important to discuss the use of alcohol whilst taking Oxybutynin. Mention to your doctor roughly how much alcohol you drink.  Alcohol can intensify the side effects.
  • If you need to have any type of surgery whilst on Oxybutynin, even if it is a simple surgery such as dental surgery, mention your use of Oxybutynin to the surgeon or dentist.
  • Be cautious about driving or operating heavy machinery until you know how Oxybutynin affects you. It is advisable to avoid these tasks when you first begin treatment.
  • You may need to avoid extreme heat whilst taking Oxybutynin. This is because Oxybutynin can make it difficult for your body to cool down.  If you begin to feel any symptoms of a heat stroke (dizziness, headache, nausea, increased heartbeat or confusion), contact your doctor or go to the nearest emergency room.6,10

 

Warnings for Special Groups

  • If you are pregnant or breastfeeding, mention this to your doctor before prescription or as soon as you find out you are pregnant. There is a concern that Oxybutynin could pass through the placenta or into breastmilk, but the risk is small.  Depending on how severe your condition is, the benefits may outweigh the risk.3
  • If you are 65 years old or older, discuss the benefits and risks of taking Oxybutynin with your doctor.3 The following are examples of possible risks for you:
    • If you on various medications, you are at a higher risk of experiencing drug-drug interactions (see the next section).
    • You are also more at risk of experiencing side effects, such as dry mouth, nose and eyes, as well as constipation, mental impairment or memory loss.

There are other medications that may be safer and more beneficial for you that can treat the same condition.3,10

 

Major Oxybutynin Drug Interactions

There are certain medications that interact with Oxybutynin.  This can result in poor absorption and efficiency.  These drug-drug interactions could also cause intensified side effects.6,10  Your doctor may therefore adjust your doses accordingly and monitor the side effects carefully.

Let your doctor know if you are on any of the following medications:

  • Amiodarone (Cordarone, Pacerone).
  • Antibiotics:
    • clarithromycin (Biaxin)
    • erythromycin (E.E.S., E-Mycin, Erythrocin)
    • tetracycline (Bristamycin, Sumycin, Tetrex)
  • Antifungals:
    • itraconazole (Sporanox)
    • miconazole (Monistat)
    • ketoconazole (Nizoral)
  •  
  • Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs):
    • ibuprofen (Advil, Motrin)
    • naproxen (Aleve, Naprosyn)
  • Cimetidine (Tagamet).
  • Diltiazem (Cardizem, Dilacor, Tiazac).
  •  
  • Human immunodeficiency virus (HIV) medications:
    • Indinavir (Crixivan)
    • nelfinavir (Viracept)
    • ritonavir (Norvir, in Kaletra).
  • Ipratropium (Atrovent).
  • Iron supplements.
  • Osteoporosis medications:
    • alendronate (Fosamax)
    • ibandronate (Boniva)
    • risedronate (Actonel).
  •  
  • Potassium supplements.
  •  
  • Verapamil (Calan, Covera, Isoptin, Verelan).6,10

 

Drug Compared to Other Similar Drugs

Oxybutynin is not the only anticholinergic drug that can be used to treat OAB.7-8  There are several drugs that act in the same way as Oxybutynin:

  • Flavoxate was the first anticholinergic drug approved by the Food and Drug Administration (FDA).8
  • Oxybutynin and tolterodine were later developed. These drugs were both more effective than flavoxate, so soon replaced it in the treatment of OABOxybutynin and tolterodine  are equal in effectiveness, but tolterodine usually has less side effects.7-8
  • Darifenacin, solifenacin, trospium and fesoteridine are more recent anticholinergic drugs approved by the FDA. These new drugs have a better ability to focus on target muscles.  This means that there is less of an effect on other body muscles and therefore less side effects.  It is important to note that fesoteridine may cause greater withdrawal symptoms than the others.7-8

In general, there is not a large difference between how effective the different anticholinergic drugs are, but oxybutynin does have a greater chance of causing side effects.

 

Abuses of Oxybutynin

Because of its mind-altering effect, oxybutynin can become addictive.  When taken in large amounts, oxybutynin can create a feeling of delirium and euphoria.9  These feelings can effectively “numb” anxiety and depression.  It is important to watch out for signs of oxybutynin abuse if you or someone you know is using it.9

There are three main groups that have been highlighted in cases of oxybutynin abuse:

  • People who have no medical need for taking oxybutynin, but who consume it only for its euphoric effects.
  • People who have been prescribed oxybutynin for legitimate conditions, but who have become dependent on its euphoric effects.
  • People who have been prescribed oxybutynin for legitimate conditions, but who begin to use it to relieve symptoms of other mental conditions, such as depression or schizophrenia.9

There are some serious dangers of oxybutynin abuse:

  • Withdrawal symptoms, such as sweating and hallucinations.9
  • Possible overdose, which can lead to vomiting, fever, dehydration, cardiac arrhythmia (abnormal heart rhythm), seizures, slowed breathing, coma, inability to move, memory loss and wide pupils.6,9,10

If you suspect oxybutynin overdose, immediately call your doctor or local Poison Control Centre at 1-800-222-1222.  If the person is not breathing or is struggling to breathe, get immediate medical help by calling 911.6,10  Keep oxybutynin out of reach of small children.

 

Other Important Information

Make sure you attend all your regular appointments with your doctor and report any side effects you have been experiencing.  It is also important to make sure your doses are altered if necessary.

If you notice something that looks like the shell of oxybutynin tablets in your stool, this does not mean that the tablets have not been absorbed.  It is common and nothing to worry about.

Do not give your oxybutynin to anyone else, unless they have gotten their own prescription from a doctor.6,10

 

Oxybutynin FAQ

Frequently Asked Questions (FAQ) on Oxybutynin:

  • How long does it take for oxybutynin to take effect?
    • It takes two weeks for oxybutynin to begin taking effect.
    • It then takes roughly six to eight weeks for oxybutynin to take its full effect.6,1
  • Is oxybutynin an anticholinergic?
    • Yes, oxybutynin is an anticholinergic
    • It acts by relaxing the body muscles and preventing involuntary muscle contractions. This helps to reduce the symptoms of an Overactive Bladder and hyperhidrosis.1-10,12-16
  • How long should I take Ditropan?
    • Since oxybutynin doesn’t cure the condition, but only relieves the symptoms, it may need to be taken indefinitely, unless used in conjunction with more permanent treatments.10
  • Can you drink alcohol while taking oxybutynin?
    • Alcohol can intensify the side effects of oxybutynin It is important to talk to your doctor about your use of alcohol.6,8,10
  • How often can you take oxybutynin?
    • Oxybutynin can be taken daily. The number of times and dose should be determined by your doctor.10
  • What is the half-life of oxybutynin?
    • Oxybutynin is absorbed quickly, reaching maximum blood concentration within an hour. Afterwards, the blood concentration decreases with a half-life (time it takes to reach half of its maximum blood concentration) of about two to three hours.6

 

References:

  1. Appell RA, Sand P, Dmochowski R, Anderson R, Zinner N, Lama D, Roach M, Miklos J, Saltzstein D, Boone T, Staskin DR.  Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study. Elsevier 2001;76(4): 358-363.
  2. American Urological Association.  What is overactive bladder (OAB)?  https://urologyhealth.org/urologic-conditions/overactive-bladder-(oab)
  3. Arisco AM, Brantly EK, Kraus SR. Oxybutynin extended release for the management of overactive bladder: a clinical review. Drug design, development and therapy. 2009;3:151
  4. Campanati A, Gregoriou S, Kontochristopoulos G, Offidani A. Oxybutynin for the treatment of primary hyperhidrosis: current state of the art. Skin appendage disorders. 2015;1(1):6-13.
  5. Chapple, C., Sievert, K. D., MacDiarmid, S., Khullar, V., Radziszewski, P., Nardo, C., … & Haag-Molkenteller, C. (2013). OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. European urology 64(2), 249-256.
  6. Food and Drug Association.  DITROPAN XL® (oxybutynin chloride) Extended Release Tablets, 1998.  www.accessdata.fda.gov/drugsatfda_docs/label/2009/020897s024lbl.pdf
  7. Hay-Smith J, Herbison P, Ellis G, Morris A. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2005 Jul 20;3.
  8. Hesch K. Agents for treatment of overactive bladder: a therapeutic class review. Proceedings (Baylor University. Medical Center). 2007 Jul;20(3):307.
  9. Kinik MF, Dönder F, Duymaz MK, Karakaya I.  Addiction of Oxybutynin: An Adolescent Case Report. J Addict Res Ther 2015, 6:228. doi:10.4172/2155-6105.1000228
  10. National Institute of Health.  Oxybutynin, last revised 05/15/2017. https://medlineplus.gov/druginfo/meds/a682141.html
  11. National library of Medicine.  Oxybutynin.  https://pillbox.nlm.nih.gov/pillimage/search_results.php?submit=search&splid=&getingredient=oxybutynin
  12. Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, EMBARK Study Group.  OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. The Journal of urology 2013;189(6): 2186-2193.
  13. Sievert, K. D., Chapple, C., Herschorn, S., Joshi, M., Zhou, J., Nardo, C., & Nitti, V. W. (2014). OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder. International journal of clinical practice. 68(10), 1246-1256.
  14. Souto, S. C., Reis, L. O., Palma, T., Palma, P., & Denardi, F. (2014). Prospective and randomized comparison of electrical stimulation of the posterior tibial nerve versus oxybutynin versus their combination for treatment of women with overactive bladder syndrome. World journal of urology. 32(1), 179-184.
  15. Zarowitz, B. J., Allen, C., O’shea, T., Tangalos, E. G., Berner, T., & Ouslander, J. G. (2015). Challenges in the pharmacological management of nursing home residents with overactive bladder or urinary incontinence. Journal of the American Geriatrics Society. 63(11), 2298-2307.
  16. Wolosker N, Schvartsman C, Krutman M, Campbell TP, Kauffman P, Campos JR, Puech‐Leão P. Efficacy and quality of life outcomes of oxybutynin for treating palmar hyperhidrosis in children younger than 14 years old. Pediatric dermatology. 2014;31(1):48-53.

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