Generic name for ditropan

Contents

Oxybutynin

Before taking oxybutynin,

  • tell your doctor and pharmacist if you are allergic to oxybutynin, any other medications, or any of the ingredients in oxybutynin tablets, extended-release tablets, or syrup. Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); certain antibiotics such as clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Erythrocin), and tetracycline (Bristamycin, Sumycin, Tetrex); certain antifungals such as itraconazole (Sporanox),miconazole (Monistat), and ketoconazole (Nizoral); antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); cimetidine (Tagamet); diltiazem (Cardizem, Dilacor, Tiazac); fluvoxamine; ipratropium (Atrovent); iron supplements; certain medications for human immunodeficiency virus (HIV) such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); medications for irritable bowel disease, motion sickness, Parkinson’s disease, ulcers, or urinary problems; medications for osteoporosis (a condition in which bones are weak, fragile, and can break easily) such as alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel); nefazodone; potassium supplements; quinidine; and verapamil (Calan, Covera, Isoptin, Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had narrow angle glaucoma (a serious eye condition that may cause vision loss), any condition that stops your bladder from emptying completely, or any condition that causes your stomach to empty slowly or incompletely. Your doctor may tell you not to take oxybutynin.
  • tell your doctor if you have or have ever had ulcerative colitis (a condition which causes swelling and sores in the lining of the colon and rectum); gastroesophageal reflux disease (GERD; condition in which the contents of the stomach back up into the esophagus and cause pain and heartburn); hiatal hernia (condition in which a portion of the wall of the stomach bulges outward, and may cause pain and heartburn); hyperthyroidism (condition in which there is too much thyroid hormone in the body); myasthenia gravis (a disorder of the nervous system that causes muscle weakness); fast or irregular heartbeat; high blood pressure; benign prostatic hypertrophy (BPH, enlargement of the prostate, a male reproductive organ); or heart, liver, or kidney disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oxybutynin, call your doctor.
  • talk to your doctor about the risks and benefits of taking oxybutynin tablets or syrup if you are 65 year of age or older. Older adults should not usually take oxybutynin tablets or syrup because they are not as safe and may not be as effective as other medications that can be used to treat the same condition.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oxybutynin.
  • you should know that this medication may make you drowsy or cause blurred vision. Do not drive a car or operate machinery until you know how this medication affects you.
  • talk to your doctor about the safe use of alcohol while you are taking this medication. Alcohol can make the side effects from oxybutynin worse.
  • you should know that oxybutynin may make it harder for your body to cool down when it gets very hot. Avoid exposure to extreme heat, and call your doctor or get emergency medical treatment if you have fever or other signs of heat stroke such as dizziness, nausea, headache, confusion, and fast pulse after you are exposed to heat.

Oxybutynin is the generic form of the brand-name drug Ditropan, which is used to treat overactive bladder, a condition where the bladder muscles contract uncontrollably and cause the urgent need to urinate frequently.

Oxybutynin is in a class of medications called antimuscarinics or urinary antispasmodics, which work by relaxing the bladder muscles and reducing spasms in the urinary tract.

Oxybutynin is also distributed under the brand names Ditropan XL or Urotrol. It’s most commonly prescribed to control bladder muscles in adults and children older than age 6 with spina bifida or other nervous system conditions that affect the bladder muscles.

Oxybutynin is made by Janssen Pharmaceuticals and was approved for use by the Food and Drug Administration (FDA) in 1978.

Oxybutynin Warnings

You should not use oxybutynin if you have untreated or uncontrolled glaucoma, a blockage in your stomach or intestines or if you are unable to urinate.

Tell your doctor if you have been diagnosed with liver or kidney disease, an enlarged prostate, or any other stomach disorder such as GERD, commonly known as reflux disease.

This medicine may cause your eyes to become more sensitive to light. Wearing sunglasses and avoiding too much exposure to bright light may help lessen the discomfort. Oxybutynin may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather.

Oxybutynin may control your symptoms, but it will not cure your condition. You may notice some improvement in your symptoms within the first two weeks of treatment. However, it may take up to eight weeks to experience the full benefit of Oxybutynin. You should not stop taking oxybutynin without talking to your doctor.

If you are 65 years old or older, talk to your doctor about the risks and benefits of taking oxybutynin tablets or syrup. Older adults should not take oxybutynin tablets or syrup because they are not as safe and may not be as effective as other medications that can be used to treat the same condition.

You should also inform your doctor if you have kidney disease, liver disease, heart disease, bleeding problems, dementia, glaucoma, trouble swallowing, prostate problems, trouble emptying your bladder, or any kind of digestive problem, such as colitis, constipation, or gastroesophageal reflux disease (GERD).

Oxybutynin may make you dizzy, drowsy, or cause blurred vision. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert or not able to see well.

When you first start taking oxybutynin, you may see signs of agitation, confusion, sleepiness or unusual drowsiness, or hallucinations. These symptoms should be reported to your doctor immediately.

Pregnancy and Oxybutynin

Before taking oxybutynin, make sure your doctor knows if you are pregnant or breastfeeding.

Studies done on animals have shown no evidence of harm to a fetus if oxybutynin is used in pregnancy. However, there have not been any adequate studies on pregnant humans.

If you are breastfeeding, you should weigh the benefits against the potential risks and side effects to your baby before taking oxybutynin.

Easy-to-read medicine information about oxybutynin – what it is, how to take oxybutynin safely and possible side effects.

Type of medicine Also called
  • Medicine to treat urinary symptoms such as incontinence
  • Belongs to a group of medicines known as anti-cholinergics.
  • Apo-Oxybutynin®
  • Oxybutynin®
  • Oxytrol® (patch)

What is oxybutynin?

  • Oxybutynin is used to treat some bladder control problems and urinary conditions such as overactive bladder, incontinence, urinary frequency (the need to pass urine more often than usual) and urinary urgency (the need to pass urine more urgently than usual).
  • It works by relaxing the muscles in the bladder and in this way controls the release of urine eases the symptoms.
  • Read more about bladder control problems.

Dose

  • The usual starting dose of oxybutynin is 2.5 milligrams two times a day.
  • Depending on your response, your doctor may increase your dose gradually to 5 milligrams three times a day.
  • Always take your oxybutynin exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much oxybutynin to take, how often to take it, and any special instructions.

How to take oxybutynin

  • Take oxybutynin tablets with a glass of water at the same times each day.
  • You can take oxybutynin with or without food.
  • To reduce your urinary symptoms, you must keep taking oxybutynin every day.
  • Limit drinking alcohol while your are taking oxybutynin. Alcohol can increase the risk of side effects.
  • If you forget your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Possible side effects

Like all medicines, oxybutynin can cause unwanted side effects, although not everyone gets them. Often unwanted side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Constipation
  • These are quite common when you first start taking oxybutynin.
  • Read more for advice on managing constipation
  • Tell your doctor if troublesome.
  • Dry mouth
  • To prevent dry mouth, avoid using mouthwashes with alcohol.
  • Chewing on sugar-free gum, and drinking small sips of water as needed, may also be helpful.
  • Tell your doctor if troublesome.
  • Read more about dry mouth
  • Drowsiness, sleepiness or feeling tired
  • This is common when starting oxybutynin or after increasing the dose.
  • Be careful when driving or using tools until you know how this medicine affects you.
  • Feeling dizzy
  • This usually only happens when you start your medication. It should wear off in a few weeks.
  • Try not to stand up too quickly. You are at risk of falls.
  • If you feel dizzy, don’t drive.
  • Reduced sweating
  • Fever
  • Heat stroke
  • Avoid hot environmental conditions.
  • Increase your fluid intake in hot weather or when exercising.
  • Tell your doctor if troublesome.

  • Signs of an allergic reaction such as skin rash, hives or itches, swelling of the face, lips, mouth
  • Tell your doctor immediately or ring HealthLine.

Interactions

  • Oxybutynin may interact with a few medications and herbal supplements, so check with your doctor or pharmacist.
  • Oxybutynin may also interact with some medicines available over-the-counter, without a prescription such as some antihistamines (also in anti-allergy, anti-nausea and cough/cold preparations), meclozine (e.g. Sea-legs®), prochlorperazine (e.g. Buccastem®) and anti-diarrhoeals (e.g. Diastop®). Ask your pharmacist.

Learn more

The following links provide further information on oxybutynin.
Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Oxybutynin Patient Info, UK.

Oxybutynin Extended-Release Tablets

Generic Name: Oxybutynin Extended-Release Tablets (oks i BYOO ti nin)
Brand Name: Ditropan XL

Medically reviewed by Drugs.com. Last updated on May 5, 2019.

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Uses of Oxybutynin Extended-Release Tablets:

  • It is used to treat an overactive bladder.
  • It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take Oxybutynin Extended-Release Tablets?

  • If you have an allergy to oxybutynin or any other part of this medicine (oxybutynin extended-release tablets).
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Bowel block, glaucoma, myasthenia gravis, slow moving GI (gastrointestinal) tract, or trouble passing urine.

This is not a list of all drugs or health problems that interact with this medicine (oxybutynin extended-release tablets).

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine (oxybutynin extended-release tablets) with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Oxybutynin Extended-Release Tablets?

  • Tell all of your health care providers that you take this medicine (oxybutynin extended-release tablets). This includes your doctors, nurses, pharmacists, and dentists.
  • Avoid driving and doing other tasks or actions that call for you to be alert or have clear eyesight until you see how this medicine (oxybutynin extended-release tablets) affects you.
  • Talk with your doctor before you drink alcohol or use other drugs and natural products that slow your actions.
  • Be careful in hot weather or while being active. Drink lots of fluids to stop fluid loss.
  • Good mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help with dry mouth. See a dentist often.
  • A very bad reaction called angioedema has happened with this medicine (oxybutynin extended-release tablets). Sometimes, this may be life-threatening. Signs may include swelling of the hands, face, lips, eyes, tongue, or throat; trouble breathing; trouble swallowing; or unusual hoarseness. Get medical help right away if you have any of these signs.
  • If you are 65 or older, use this medicine (oxybutynin extended-release tablets) with care. You could have more side effects.
  • Do not give this medicine (oxybutynin extended-release tablets) to a child younger than 6 years of age.
  • Some forms of this medicine (oxybutynin extended-release tablets) may not be for use in all ages of children. If you have questions, talk with the doctor.
  • Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.

How is this medicine (Oxybutynin Extended-Release Tablets) best taken?

Use this medicine (oxybutynin extended-release tablets) as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • Take with or without food.
  • Take this medicine (oxybutynin extended-release tablets) at the same time of day.
  • Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor.
  • Swallow whole. Do not chew, break, or crush.
  • Take with a full glass of water.
  • You may see the tablet shell in your stool. This is normal and not a cause for concern.

What do I do if I miss a dose?

  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of a urinary tract infection (UTI) like blood in the urine, burning or pain when passing urine, feeling the need to pass urine often or right away, fever, lower stomach pain, or pelvic pain.
  • Very bad dizziness or passing out.
  • Feeling confused.
  • Hallucinations (seeing or hearing things that are not there).
  • Feeling agitated.
  • Mood changes.
  • Fever.
  • Not sweating during activities or in warm temperatures.
  • Trouble passing urine.
  • Very bad belly pain.
  • Muscle weakness.

What are some other side effects of Oxybutynin Extended-Release Tablets?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

  • Feeling sleepy.
  • Dizziness.
  • Blurred eyesight.
  • Headache.
  • Upset stomach.
  • Constipation.
  • Diarrhea.
  • Dry mouth.
  • Feeling tired or weak.
  • Trouble sleeping.
  • Feeling nervous and excitable.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Oxybutynin Extended-Release Tablets?

  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Consumer information use

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine (oxybutynin extended-release tablets), please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

More about oxybutynin

  • Side Effects
  • During Pregnancy
  • Dosage Information
  • Patient Tips
  • Drug Images
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • 314 Reviews
  • Drug class: urinary antispasmodics
  • FDA Alerts (1)

Consumer resources

  • Oxybutynin
  • Oxybutynin transdermal
  • Oxybutynin Tablets
  • Oxybutynin Gel
  • Oxybutynin Syrup
  • … +3 more

Other brands: Ditropan, Ditropan XL, Oxytrol, Gelnique, Anturol

Professional resources

  • Oxybutynin Chloride (AHFS Monograph)
  • … +5 more

Related treatment guides

  • Hyperhidrosis
  • Dysuria
  • Urinary Frequency
  • Prostatitis
  • Spina bifida
  • Urinary Incontinence

PRECAUTIONS: Before taking oxybutynin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: active internal bleeding, untreated/uncontrolled glaucoma (narrow-angle), severe blockage/slowed movement of stomach/intestines (e.g., gastric retention, paralytic ileus), decreased bladder emptying activity (urinary retention).Before using this medication, tell your doctor or pharmacist your medical history, especially of: bladder disease (e.g., bladder outflow blockage), certain muscle disease (myasthenia gravis), heart disease (e.g., congestive heart failure, coronary artery disease, arrhythmias), high blood pressure, liver disease, kidney disease, loss of mental abilities (dementia), certain nervous system disorder (autonomic neuropathy), enlarged prostate gland (benign prostatic hypertrophy-BPH), stomach/intestinal disease (e.g., acid reflux disease, hiatal hernia, ulcerative colitis), severe throat/stomach/intestinal narrowing (strictures), overactive thyroid (hyperthyroidism).This drug may make you dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.This drug may increase the risk for heatstroke because it causes decreased sweating. Avoid becoming overheated in hot weather, saunas, and during exercise or other strenuous activity.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, confusion, constipation, trouble urinating. Drowsiness and confusion can increase the risk of falling.Tell your doctor if you are pregnant before using this medication.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: anticholinergic drugs (e.g., atropine, glycopyrrolate, scopolamine ), other antispasmodic drugs (e.g., clidinium, dicyclomine, propantheline), certain anti-Parkinson’s drugs (e.g., benztropine, trihexyphenidyl), belladonna alkaloids, bisphosphonate drugs (e.g., alendronate, etidronate, risedronate), drugs affecting liver enzymes that remove oxybutynin from your body (such as azole antifungals-including ketoconazole, macrolide antibiotics-including erythromycin, cimetidine, rifamycins-including rifabutin, St. John’s wort, certain anti-seizure medicines-including carbamazepine), potassium tablets/capsules, pramlintide.Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-anxiety drugs (e.g., diazepam), anti-seizure drugs (e.g., phenobarbital), medicine for sleep (e.g., zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine or tricyclics such as amitriptyline), tranquilizers.Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

SLIDESHOW

Urinary Incontinence in Women: Types, Causes, and Treatments for Bladder Control See Slideshow

Oxybutynin for daytime urinary symptoms

This leaflet is about the use of oxybutynin for urinary symptoms including daytime wetting, frequent passing of urine and urgency to pass urine.

This leaflet has been written for parents and carers about how to use this medicine in children. Our information sometimes differs from that provided by the manufacturers, because their information is usually aimed at adult patients. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Name of drug

Oxybutynin
Common brands: Cystrin®, Ditropan®
Modified-release tablets: Lyrinel XL®

Why is it important for my child to take this medicine?

Oxybutynin relaxes the muscles of the bladder. This will mean that the bladder can hold more urine (wee) and will help your child to control their bladder so that they do not wet themselves.

What is oxybutynin available as?

  • Tablets: 2.5 mg, 2.5 mg, 3 mg, 5 mg; these contain a small amount of lactose
  • Modified-release tablets (Lyrinel XL): 5 mg, 10 mg; these contain a small amount of lactose
  • Liquid medicine: 2.5 mg in 5 mL

When should I give oxybutynin?

Oxybutynin tablets or medicine may be given two or three times each day. There is a special, modified-release tablet called Lyrinel XL that is given once a day.

Twice each day

  • If it is to be given twice each day, this should be given once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example some time between 7 and 8 am, and between 7 and 8 pm.

Three times each day

  • If it is to be given three times a day, this should be first thing in the morning, early afternoon (or after school) and at bedtime. Ideally, these times should be at least 4 hours apart

Modified-release (Lyrinel XL) tablets

  • These tablets are given only once a day.

Give the medicine at about the same times each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of oxybutynin (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it?

Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet.

Modified-release tablets (Lyrinel XL) should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet, because this will change how it works.

Liquid medicine: Measure out the right amount using an oral syringe or medicine spoon. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

When should the medicine start working?

It may take a few days (sometimes a week or more) for the medicine to help your child’s bladder symptoms. Continue to give the medicine as your doctor has told you to during this time.

What if my child is sick (vomits)?

  • If your child is sick less than 30 minutes after having a dose of oxybutynin, give them the same dose again.
  • If your child is sick more than 30 minutes after having a dose of oxybutynin, you do not need to give them another dose. Wait until the next normal dose.

If your child is sick again, seek advice from your GP, pharmacist or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

What if I forget to give it?

If you normally give oxybutynin twice a day
If you remember up to 4 hours after you should have given a dose, give your child the missed dose. For example, if you usually give a dose at about 7 am, you can give the missed dose at any time up to 11 am. If you remember after that time, do not give the missed dose. Wait until the next normal dose.

If you normally give oxybutynin three times a day
If you miss a dose, wait until the next normal dose. Do not give the missed dose.

Modified-release (Lyrinel XL)
If you forget to give a dose, you can give the missed dose first thing in the morning, as long as this is at least 12 hours before the next normal bedtime dose. If you remember after this, do not give the missed dose. You do not need to wake your child up to give them the missed dose.

Never give a double dose of oxybutynin.

What if I give too much?

If you think you may have given your child too much oxybutynin, contact your doctor or local NHS services (111 in England and Scotland; 0845 4647 in Wales). Have the medicine packet with you if you telephone for advice.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Side-effects you must do something about
  • Your child may sweat less whilst taking oxybutynin. Be careful that they don’t overheat, particularly in hot weather and during exercise; make sure that they drink plenty of water.

Your child may get a fast or irregular heartbeat (a fluttery feeling in the chest). Contact your doctor straight away if this happens.

  • Your child’s skin may become more sensitive to sunlight. Keep them out of strong sun. When outdoors they should wear long-sleeved tops and trousers and a hat, and use high-factor sun block (at least SPF 15).
Other side-effects you need to know about
  • Some children get a dry mouth for the first few days. Eating citrus fruits (e.g. oranges) and taking sips of water may help. This effect usually settles down quite quickly. If it doesn’t, contact your doctor.
  • Your child may feel sick (nausea) and get diarrhoea or constipation (difficulty doing a poo). If these effects cause problems, your doctor may give you some other medicines to help.
  • Your child may have some problems passing urine (doing a wee). If this happens, contact your doctor.
  • Some children may feel sleepy, get a headache, have changes in mood, see strange things (hallucinations), or get nightmares (although this is rare). Some children find that their eyesight is blurry or double.

These side-effects should get better after a week. If they don’t, contact your doctor.

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side-effects to a UK safety scheme at http://www.mhra.gov.uk/yellowcard.

Can other medicines be given at the same time as oxybutynin?

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

General advice about medicines

  • Try to give the medicine at about the same time(s) each day, to help you remember.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • If you think someone else may have taken the medicine by accident, contact your doctor straight away.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information

Your child’s doctor, pharmacist or nurse will be able to give you more information about oxybutynin and about other medicines used to treat daytime urinary symptoms.

Generic Name: oxybutynin (oral) (OX i BUE ti nin)
Brand Names: Ditropan XL

Medically reviewed by Sanjai Sinha, MD Last updated on Jan 13, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

Oxybutynin reduces muscle spasms of the bladder and urinary tract.

Oxybutynin is used to treat symptoms of overactive bladder, such as frequent or urgent urination, incontinence (urine leakage), and increased night-time urination.

Oxybutynin may also be used for purposes not listed in this medication guide.

Important Information

You should not use oxybutynin if you have untreated or uncontrolled narrow-angle glaucoma, a blockage in your digestive tract (stomach or intestines), or if you are unable to urinate.

Before using oxybutynin, tell your doctor if you have glaucoma, liver or kidney disease, an enlarged prostate, myasthenia gravis, ulcerative colitis, a blockage in your stomach or intestines, or a stomach disorder such as gastroesophageal reflux disease (GERD) or slow digestion.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Oxybutynin can decrease perspiration and you may be more prone to heat stroke.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

There are many other medicines that can interact with oxybutynin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Stop using this medication and call your doctor if you have serious side effects such as hot and dry skin, extreme thirst, severe stomach pain or constipation, pain or burning when you urinate, or if you stop urinating.

Before taking this medicine

You should not use this medication if you are allergic to oxybutynin, or if you have:

  • untreated or uncontrolled narrow-angle glaucoma;

  • a blockage in your digestive tract (stomach or intestines); or

  • if you are unable to urinate.

To make sure oxybutynin is safe for you, tell your doctor if you have:

  • glaucoma;

  • liver disease;

  • kidney disease;

  • an enlarged prostate;

  • ulcerative colitis;

  • Parkinson’s disease;

  • a nerve disorder that affects your heart rate, blood pressure, or digestion;

  • a muscle disorder such as myasthenia gravis; or

  • a stomach disorder such as gastroesophageal reflux disease (GERD) or slow digestion.

Tell your doctor if you are pregnant or breastfeeding.

How should I take oxybutynin?

Take oxybutynin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take this medicine with a full glass of water, at the same time each day.

Oxybutynin may be taken with or without food.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using oxybutynin?

Avoid driving or hazardous activity until you know how oxybutynin will affect you. Your reactions could be impaired.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Oxybutynin can decrease sweating and you may be more prone to heat stroke.

Drinking alcohol with this medicine can increase side effects.

Oxybutynin side effects

Get emergency medical help if you have signs of an allergic reaction to oxybutynin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have:

  • severe stomach pain or constipation;

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • little or no urination;

  • painful or difficult urination; o

  • dehydration symptoms–feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;

Side effects such as dry mouth, constipation, and confusion may be more likely in older adults.

Common oxybutynin side effects may include:

  • dizziness, drowsiness;

  • blurred vision;

  • dry mouth; or

  • diarrhea, constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect oxybutynin?

Using oxybutynin with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

  • medicine to treat depression, anxiety, mood disorders, or mental illness;

  • cold or allergy medicine (Benadryl and others);

  • medicine to treat Parkinson’s disease;

  • medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;

  • medicine to treat overactive bladder; or

  • bronchodilator asthma medication.

This list is not complete. Other drugs may interact with oxybutynin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use oxybutynin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Selecting Medications for the Treatment of Urinary Incontinence

Treatment

Jump to section +

The patient should be treated for urge or stress incontinence based on the factors listed in Table 3. Some patients will exhibit symptoms suggestive of both urge and stress incontinence. This so-called mixed incontinence occurs in 25 to 35 percent of patients.3 When the evaluation suggests mixed incontinence, treatment should be directed at whichever type seems predominant.

TREATMENT OF URGE INCONTINENCE

The anticholinergic agents oxybutynin (Ditropan; Oxytrol) and tolterodine (Detrol) are used widely to treat urge incontinence. These medications are not, however, the most effective therapies. Behavior therapies are more effective, and they—not medications—should be first-line treatment.

Behavior Therapy

Behavior therapies for urge incontinence include bladder training and pelvic floor muscle (Kegel) exercises. Bladder training (i.e., learning to hold urine longer and longer between voids) is more effective than oxybutynin and improves incontinence in more than 50 percent of patients.6 Kegel exercises are even more effective. In a randomized controlled trial (RCT)7 comparing Kegel exercises with oxybutynin in patients with urge incontinence, patients performing Kegel exercises had an 81 percent reduction in incontinence episodes compared with a 69 percent decrease in oxybutynin-treated patients, a statistically significant difference.

Although biofeedback commonly is used to help patients learn effective Kegel technique, evidence suggests that biofeedback training does not result in decreased frequency of incontinence episodes compared with Kegel exercises alone.8 Physicians should keep in mind that successful use of Kegel exercises is dependent on a patient’s motivation and ability to cooperate with the exercise routine.

Treatment for urge incontinence generally should include behavior therapy. However, medications can be prescribed as an adjunct to behavior therapy. Indeed, the combination of Kegel exercises and medications results in better control of incontinence than either treatment alone.9

Medications

When prescribing medications for urge incontinence, physicians must decide which agent to use. One option is oxybutynin, a nonselective anticholinergic agent available in short- and long-acting oral forms (Ditropan) and as a transdermal patch (Oxytrol). Tolterodine, a selective anticholinergic agent, has relatively more action on cholinergic receptors in the bladder than in the salivary glands and other organs. It is available in short- and long-acting oral forms. The long-acting formulations of oxybutynin and tolterodine are preferred over their short-acting counterparts because they are more effective in controlling incontinence symptoms and cause fewer anticholinergic side effects.10–12 Older anticholinergic agents, such as scopolamine (Transderm Scop) and hyoscyamine, have little role in the modern management of urge incontinence.

Data on which to base selection of one anticholinergic agent over another are limited. Studies have compared short-acting oral oxybutynin with short-acting oral tolterodine.13 These studies found short-acting oxybutynin to be slightly more effective in controlling incontinence, but short-acting tolterodine has fewer anticholinergic side effects and is better tolerated.

Similar results were found in a recent study14 comparing long-acting oral oxybutynin with long-acting tolterodine. This study, sponsored by the manufacturers of oxybutynin, randomized almost 800 patients with urge incontinence to receive 10 mg of long-acting oxybutynin per day or 4 mg of long-acting tolterodine per day. After 12 weeks, patients in both groups had similar reductions in incontinence episodes (from about 37 per week to 11 per week). Slightly more patients in the oxybutynin group had no episodes of incontinence (23 versus 17 percent in the tolterodine group), but oxybutynin-treated patients had a 50 percent higher rate of moderate or severe dry mouth.

Transdermal oxybutynin is the newest anticholinergic agent available for treating urge incontinence. It is more effective than placebo in reducing episodes of urge incontinence.15 The one published study16 comparing transdermal oxybutynin with oral anticholinergics used oral, long-acting tolterodine as the comparison drug. This 12-week study, sponsored by the manufacturer of transdermal oxybutynin, found that the transdermal agent was as effective as oral tolterodine and caused fewer anticholinergic side effects, presumably because of the “smoother” release of the drug from a transdermal patch. Cutaneous side effects, however, were frequent: 20 percent of patients reported moderate to severe reactions. It is not clear how this study applies to primary care patients with a new diagnosis of urge incontinence, because the study enrolled subjects with both urge and mixed incontinence who had been on long-term treatment with anticholinergic drugs. Furthermore, an independent analysis17 of transdermal oxybutynin concluded that this agent probably is less effective than oral medications for controlling incontinence.

The limited number of comparisons between drugs for treatment of urinary incontinence leaves physicians in a quandary about which medication is best. A recent Cochrane review18 concluded only that anticholinergics, as a class, are superior to placebo for treating urge incontinence. It provided no guidance about which agent is superior. Another recent authoritative review19 suggested that all of the anticholinergic drugs have similar efficacy.

Until further research in primary care settings is performed, there is little evidence to guide family physicians in the choice of anticholinergic medications for urge incontinence. Cost is not an important factor; prices for all of these agents are similar (Table 4). Patients who prefer a transdermal preparation may be candidates for transdermal oxybutynin, assuming they do not experience cutaneous side effects. The choice between long-acting oral tolterodine and long-acting oral oxybutynin is more difficult and depends largely on whether more emphasis is put on having slightly better control of incontinence (in which case oxybutynin is preferred) or minimizing anticholinergic side effects (in which case tolterodine is preferred). Common anticholinergic side effects include constipation and dry mouth (which, in addition to being unpleasant, can lead to dental caries in some patients). Anticholinergic agents may worsen cognitive function and should be used with caution in patients with dementia; limited evidence suggests that tolterodine may have less effect on the central nervous system.20 Anticholinergic agents are contraindicated in patients with angle-closure glaucoma and urinary outflow obstruction.

TABLE 4

Medications for Treatment of Urge Incontinence

Agent Dosage Cost*

Oral agents

Oxybutynin (Ditropan XL)

Low dosage

5 mg daily

$ 94

Intermediate dosage

10 mg daily

96 to 107

Maximum dosage

30 mg daily

212 to 224

Tolterodine (Detrol)

Low dosage

2 mg daily

Maximum dosage

4 mg daily

95 to 107

Transdermal agent

Oxybutynin (Oxytrol)

One patch twice weekly

86 to 95

*—Estimated cost to the pharmacist for one month’s treatment based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2004. Cost to the patient will be higher, depending on prescription filling fee.

TABLE 4

Agent Dosage Cost*

Oral agents

Oxybutynin (Ditropan XL)

Low dosage

5 mg daily

$ 94

Intermediate dosage

10 mg daily

96 to 107

Maximum dosage

30 mg daily

212 to 224

Tolterodine (Detrol)

Low dosage

2 mg daily

Maximum dosage

4 mg daily

95 to 107

Transdermal agent

Oxybutynin (Oxytrol)

One patch twice weekly

86 to 95

*—Estimated cost to the pharmacist for one month’s treatment based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2004. Cost to the patient will be higher, depending on prescription filling fee.

Electrical Therapy

Electrical therapy is indicated in patients with severe refractory urge incontinence who do not respond to behavior therapy and medications. Treatment is administered through a generator device that is inserted into the subcutaneous tissue of the lower back or buttocks. The generator powers a lead that typically is placed through the sacral foramen to stimulate the S3 sacral nerve to decrease detrusor muscle contractions.

Given that patients receiving this treatment have severe incontinence that has been unresponsive to other therapies, the device is remarkably effective: most patients experience symptomatic improvement, and some become dry.21,22 The device costs about $10,000, plus a similar amount for costs associated with surgical implantation; these costs are covered by Medicare.

TREATMENT OF STRESS INCONTINENCE

When treating a female patient with stress incontinence, many physicians consider only Kegel exercises and surgery. There are, however, many other therapies available (Table 5).23

TABLE 5

Treatments for Urinary Stress Incontinence in Women

Treatment

Behavior therapy

Pelvic floor muscle (Kegel) exercises

Safe but time consuming. Appropriate in highly motivated patients with ability to contract pelvic muscles who have no evidence of pelvic prolapse.

…with biofeedback

Improves patient’s ability to correctly identify contraction of pelvic muscles. No evidence of long-term benefit for decreasing incontinence frequency.

…with vaginal weights (cones)

May improve patient’s ability to correctly contract pelvic muscles.No evidence of benefit compared with Kegel exercises alone.

Medications

Alpha-adrenergic stimulants

Not FDA-approved for treatment of stress incontinence. No good evidence of efficacy. May be appropriate in patients with other indications for these medications.

Estrogen

Duloxetine

Balanced and selective serotonin and norepinephrine reuptake inhibitor that increases urethral sphincter contraction during the storage phase of urination cycle. In final stages of FDA review.

Devices

Extracorporeal magnetic innervation (ExMI) chair

Patient sits in an FDA-approved chair that stimulates pelvic muscles via a low-intensity magnetic field. Treatments are administered twice weekly in 20-minute sessions for 8 weeks. Appropriate in patients with uncomplicated, mild stress incontinence who have never undergone surgery.

Intravaginal support devices

Can be used on a temporary or occasional basis, such as in patients with exercise-induced incontinence. Requires manipulation and manual dexterity.

Pessaries

Can be used on a temporary or long-term basis; often used in older patients who have not responded to other therapies. Long-term use requires monitoring for vaginal infection and ulceration.

Urethral occlusion inserts (plugs)

Can be used on a temporary or occasional basis, such as for exercise-induced incontinence. Requires manipulation and manual dexterity.

Invasive treatments

Colposuspension procedures

Most effective treatment, but incontinence may recur over time. Best treatment in patients with stress incontinence accompanied by uterine prolapse.

Tension-free vaginal tape procedure

Urethral sling created under local anesthesia, often in outpatient surgical unit. Effectiveness similar to that of colposuspension.

Injection of bulking agents

Periurethral injection of collagen results in high short-term cure rates, but effectiveness diminishes over time. Appropriate in patients with difficult-to-control incontinence in whom urodynamic testing reveals intrinsic sphincter deficiency.

FDA = U.S. Food and Drug Administration.

Adapted with permission from Weiss BD, Newman DK. New insight into urinary stress incontinence: advice for the primary care clinician. Accessed online November 12, 2004, at:http://www.medscape.com/viewprogram/1961.

TABLE 5

Treatment

Behavior therapy

Pelvic floor muscle (Kegel) exercises

Safe but time consuming. Appropriate in highly motivated patients with ability to contract pelvic muscles who have no evidence of pelvic prolapse.

…with biofeedback

Improves patient’s ability to correctly identify contraction of pelvic muscles. No evidence of long-term benefit for decreasing incontinence frequency.

…with vaginal weights (cones)

May improve patient’s ability to correctly contract pelvic muscles.No evidence of benefit compared with Kegel exercises alone.

Medications

Alpha-adrenergic stimulants

Not FDA-approved for treatment of stress incontinence. No good evidence of efficacy. May be appropriate in patients with other indications for these medications.

Estrogen

Duloxetine

Balanced and selective serotonin and norepinephrine reuptake inhibitor that increases urethral sphincter contraction during the storage phase of urination cycle. In final stages of FDA review.

Devices

Extracorporeal magnetic innervation (ExMI) chair

Patient sits in an FDA-approved chair that stimulates pelvic muscles via a low-intensity magnetic field. Treatments are administered twice weekly in 20-minute sessions for 8 weeks. Appropriate in patients with uncomplicated, mild stress incontinence who have never undergone surgery.

Intravaginal support devices

Can be used on a temporary or occasional basis, such as in patients with exercise-induced incontinence. Requires manipulation and manual dexterity.

Pessaries

Can be used on a temporary or long-term basis; often used in older patients who have not responded to other therapies. Long-term use requires monitoring for vaginal infection and ulceration.

Urethral occlusion inserts (plugs)

Can be used on a temporary or occasional basis, such as for exercise-induced incontinence. Requires manipulation and manual dexterity.

Invasive treatments

Colposuspension procedures

Most effective treatment, but incontinence may recur over time. Best treatment in patients with stress incontinence accompanied by uterine prolapse.

Tension-free vaginal tape procedure

Urethral sling created under local anesthesia, often in outpatient surgical unit. Effectiveness similar to that of colposuspension.

Injection of bulking agents

Periurethral injection of collagen results in high short-term cure rates, but effectiveness diminishes over time. Appropriate in patients with difficult-to-control incontinence in whom urodynamic testing reveals intrinsic sphincter deficiency.

FDA = U.S. Food and Drug Administration.

Adapted with permission from Weiss BD, Newman DK. New insight into urinary stress incontinence: advice for the primary care clinician. Accessed online November 12, 2004, at:http://www.medscape.com/viewprogram/1961.

Nonpharmacologic Treatments

Stress incontinence can be treated with intravaginal support devices, pessaries, and urethral “plugs.” Collagen can be injected alongside the urethra as a bulking agent to improve urethral closure. Patients also can be treated with the extracorporeal magnetic innervation (ExMI) chair, which has been approved by the U.S. Food and Drug Administration (FDA) for this purpose. This device strengthens pelvic floor muscles through application of a low-intensity magnetic field.24,25 All of these modalities have a role in the treatment of stress incontinence.

There are no high-quality clinical trials comparing these treatments, which leaves physicians uncertain about the best approach to therapy. Table 5 offers some suggestions, based on generally accepted clinical practice, for selecting treatments for patients with stress incontinence.

Alpha-adrenergic agonists and estrogens sometimes are used to treat stress incontinence, and one new medication, duloxetine (Yentreve), is currently under review by the FDA as a treatment for stress incontinence (and has been approved for the treatment of depression under the brand name Cymbalta). Anticholinergics (i.e., oxybutynin and tolterodine) are neither appropriate nor effective in treating stress incontinence.

Alpha-adrenergic agonists stimulate urethral closure, and studies26,27 conducted decades ago suggested benefit in the treatment of stress incontinence. Most studies evaluated phenylpropanolamine,26 which later was withdrawn from the market when it was linked to intracerebral hemorrhage. One additional study27 from 1975 found ephedrine to be effective in treating stress incontinence, but current standards preclude using ephedrine for this indication.

Pseudoephedrine (Sudafed), which is available without a prescription, sometimes is recommended for treatment of stress incontinence because its actions are similar to those of phenylpropanolamine and ephedrine. There are, however, no published studies evaluating pseudoephedrine in the treatment of stress incontinence, and the FDA has not approved this use of the product.

Estrogen has been used widely to treat stress incontinence. The rationale for estrogen therapy is its ability to increase urethral vascularity and thickness, and to sensitize α-adrenergic receptors in the bladder neck, both of which theoretically could improve urethral closure. Although some early studies suggested a benefit from estrogen—particularly from topical estrogens—a review and meta-analysis28 of 23 published studies found no objective improvement in measured urine loss. A small, more recent RCT29 supported these results, finding no benefit with estrogen therapy in treating stress incontinence.

The lack of evidence that estrogen therapy improves stress incontinence, combined with concerns about estrogen supplementation raised by the Women’s Health Initiative,30 has made estrogen a poor choice for treatment of stress incontinence. Furthermore, the FDA has not approved estrogen therapy for this indication.

Duloxetine is a combined and balanced inhibitor of serotonin and norepinephrine reuptake. The drug has efficacy in the treatment of depression,31 and the FDA has granted the drug “approvable” status as a treatment for stress incontinence; a final decision is pending. Duloxetine increases serotonin and norepinephrine levels in the sacral spinal cord, thereby enhancing pudendal nerve activity, which in turn leads to increased contraction of the urethral sphincters during the urine storage phase of the micturition cycle—a potential benefit in stress incontinence.

In two RCTs32,33 including more than 1,100 women treated with duloxetine at varying dosages, those taking duloxetine had a 54 to 64 percent reduction in incontinence episodes, compared with a 41 percent reduction in control patients. The most common side effect is nausea, which often resolves with continued use of the drug. If the FDA authorizes marketing of duloxetine for treatment of stress incontinence, it will be the first medication approved for this indication.

Until and unless duloxetine is approved for the treatment of stress incontinence, no strong recommendations can be made for pharmacologic treatment. Other treatment modalities (Table 5) are safer and possibly more effective. In patients with occasional stress incontinence and another indication for pseudoephedrine or estrogen treatment, it might be reasonable to prescribe these medications.

Addiction of Oxybutynin: An Adolescent Case Report

Mehmet Fatih Kinik1, Funda Dönder1, Mustafa Kenan Duymaz2 and Isik Karakaya1

1Department of Child and Adolescent Psychiatry, School of Medicine, Kocaeli University, Kocaeli, Turkey

2Department of Child and Adolescent Psychiatry, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey

Corresponding Author: Mehmet Fatih Kinik
Department of Child and Adolescent Psychiatry
School of Medicine, Kocaeli University, Kocaeli, Turkey
Tel: 0905552966093
E-mail:

Received date: April 29, 2015; Accepted date: May 27, 2015; Published date: June 04, 2015

Copyright: © 2015 Kinik MF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Addiction Research & Therapy

Abstract

Oxybutynin is an antimuscarinic substance used frequently for the treatment of overactive bladder and nocturnal enuresis. During the use of such anticholinergic substances, such effects as the decrease in depressive symptoms, euphoria effect, relaxation and the alleviation of the side-effects of neuroleptic medications could be seen. In this case report, an adolescent who was referred to our clinic because of oxybutynin abuse and a suicide attempt has presented. According to the criteria of the DSM-V, other (or unknown) substance use disorder was diagnosed. Oxybutynin is among the non-controlled drugs and can be obtained easily without prescription in Turkey. In the literature this is the first case of Oxybutynin abuse in an adolescent. This case has been presented for the purpose of drawing attention to the oxybutynin abuse which is a growing problem among adolescents.

Keywords

Addiction; Adolescent; Oxybutynin; Anticholinergics

Introduction

Oxubutynin is a medicine with anticholinergic and antispasmodic effects that is used to treat overactive bladder and nocturnal enuresis . Anticholinergic substances have a number of effects, such as decreasing depressive symptoms, causing euphoria, improving relaxation, and reducing the side-effects of neuroleptic medications . One double blind, randomized study found that biperidene, another anticholinergic drug, caused euphoria and elevated mood in a healthy adults .

A Jordanian study found that anticholinergic drugs are the 5th most abused drug class, after opiates, cocaine, marijuana, and amphetamines. Biperidene, benztropine, and procyclidine are the most abused anticholinergic drugs . Although research about the abuse of anticholinergics is limited, a review conducted in 2000 found that 141 cases of anticholinergic drug abuse were reported between 1960 and 1996. Anticholinergics were used in half the cases to reduce the sideeffects of neuroleptic drugs, and they were used in 48 cases to overcome addiction to other substances. Patients addicted to a substance are less likely to use anticholinergic drugs than other substances . For instance, only 0.25% of patients in a drug advisory service in Germany were reported to use anticholinergic drugs between 1988 and 1994 ; Burich et al. reported that 34% of 50 patients with chronic psychiatric disorders abused anticholinergic drugs .

The present report describes the case of an adolescent who was referred to our clinic because of oxybutynin abuse and a suicide attempt.

Case Report

A 17-year-old female was referred to the child and adolescent psychiatry department by pediatric emergency services because of a suicide attempt. According to the history taken from the patient and her mother, the patient attempted suicide, after quarrelling with her friend, by taking a drug containing oxybutynin.

During the interview, the patient acknowledged engaging in selfdestructive behaviors when she was angry and having attempted suicide once before. She reported she had issues with her relatives and had difficulty making decisions, and described her mood as “unstable.” After breaking-up with her boyfriend one and a half years ago, she used a drug called “bonzai” for a month. She overcame that addiction by herself, with her mother’s help.

The patient said she started using oxybutynin to “get high,” based on the advice of a friend. She said she initially took eight oxybutynin tablets (40 mg) a month, but gradually increased her use of oxybutynin, and within a year was taking about 20 tablets (100 mg) almost every day. The patient stated she needed to take oxybutynin despite the sideeffects, which included xerostomia, somnolence, difficulty breathing, and blurred vision. The oxybutynin caused visual and auditory hallucinations – e.g., seeing friends and a nurse telling her to wear her pyjamas – that she said made her happy. She said that when she did not take oxybutynin, she had hand tremors, anxiety, sweating, and difficulty in social relationships. She reported having no problem obtaining oxybutynin and could easily get it from a pharmacy without a prescription. She spent less time with friends due to her use of oxybutynin and she became bored with her social circle.

A month and a half ago, the patient tried to quit oxybutynin and a psychiatrist prescribed mirtazapine, topiramate, propranolol, and aripiprazole. Her hallucinations ended after quitting oxybutynin, but she started drinking alcohol to reduce the withdrawal symptoms. In the past month, she overdosed on oxybutynin to commit suicide, and was treated in the intensive care unit twice.

Mental status examination: The patient looked younger than her stated age, had tattoos on both arms, and was well groomed and well dressed. She did not have difficulty making eye-contact, looked eager to communicate, was articulate, and answered questions spontaneously. Her thought processes were coherent and goal directed. Her thoughts included themes about past suicide attempts, craving for oxybutynin, family issues, and worthlessness. Her affect and mood were depressed. She was alert and oriented to time, person, and place. She appeared to maintain attention and concentrate on the interviewer’s tasks and questions. Her past and recent memory was intact. She had some visual and auditory hallucinations, but her intellectual functioning appeared to be normal.

The patient was enrolled in a child-psychiatry outpatient clinic for follow-up and treatment. According to the criteria of the DSM-V, other (or unknown) substance use disorder was diagnosed. Aripiprazole of 5 mgs twice a day and sertraline of 50 mgs once a day was started for depressive and hallucinatory symptoms.

Discussion

This report presented the case of an adolescent whose use of oxybutynin met the DSM-V criteria for other (or unknown) substance use disorder. The misuse of oxybutynin was recognized only recently.

Oxybutynin is not restricted by the Turkish Ministry of Health, which makes it easy to obtain it from pharmacies without a prescription. According to the information presented in this case, the rate of misusing this drug is gradually increasing among youth because it is accessible and inexpensive. However, this information must be supported by epidemiological studies.

Although there is no current explanation for addiction to anticholinergic drugs, the mesolymbic dopaminergic system, ventral tegmental area, nucleus accumbens, and prefrontal cortex are considered to be the main neurological pathways responsible for drug addiction ; the cholinergic system also is considered to have a role in addiction. Activation of muscarinic receptors facilitates dopamine release and transmission to the nucleus accumbens. Blockage of muscarinic receptors also blocks dopamine re-uptake and storage, thus causing euphoria and deliriogenic effects . Hence, euphoria and deliriogenic effects could cause addiction to anticholinergic drugs, as found in our patient. Marken et al reviewed 110 cases of reported anticholinergic abuse and identified three distinct groups of abusers:

• Individuals without valid medical need for the medication who consume it merely for its mind-altering effects

• Patients with valid indication for the use of anticholinergics who also abuse the agents for mind-altering effects

• Patients with an appropriate medical indication for the agent who appear to use anticholinergics to relieve chronic or subclinical extrapyramidal symptoms, depression, or negative schizophrenic symptoms.

Marken et al. characterized the individuals in the first group as “true abusers”. If this classification is adapted to our patients first item describes our patient. Although there was no medical indication, our patient reported using oxybutynin to “get high.”

Drug effects (e.g., pleasing hallucinations and decreased anxiety) and withdrawal symptoms (e.g., tremors and sweating), like those reported by our patient, have been identified as maintenance factors for substance use. Easy access and low cost also contribute to the development of drug addiction, and having chaotic family-relations is a predisposing factor for substance use and suicide attempts.

To our knowledge, this is the first case of oxybutynin abuse by an adolescent to be reported in the research literature. This case was presented to draw attention to the abuse of oxybutynin, which is easily accessible in Turkey.

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