(oks i BYOO ti nin)
- Oxybutynin Chloride
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Gelnique: 3% (92 g [DSC]) [contains propylene glycol]
Gel, Transdermal, as chloride:
Gelnique: 10% (1 g) [contains alcohol, usp]
Gelnique Pump: 10% (30 g)
Patch Twice Weekly, Transdermal:
Oxytrol: 3.9 mg/24 hr (1 ea, 2 ea, 4 ea, 8 ea)
Oxytrol For Women: 3.9 mg/24 hr (4 ea, 8 ea)
Syrup, Oral, as chloride:
Generic: 5 mg/5 mL (473 mL)
Tablet, Oral, as chloride:
Generic: 5 mg
Tablet Extended Release 24 Hour, Oral, as chloride:
Ditropan XL: 5 mg, 10 mg, 15 mg [contains polysorbate 80]
Generic: 5 mg, 10 mg, 15 mg
Brand Names: U.S.
- Ditropan XL
- Gelnique Pump
- Oxytrol For Women [OTC]
- Antispasmodic Agent, Urinary
Direct antispasmodic effect on smooth muscle, also inhibits the action of acetylcholine on smooth muscle (exhibits 1/5 the anticholinergic activity of atropine, but has 4-10 times the antispasmodic activity); does not block effects at skeletal muscle or at autonomic ganglia; increases bladder capacity, decreases uninhibited contractions, and delays desire to void, therefore, decreases urgency and frequency
Oral: Rapid and well absorbed; Transdermal: High
IV: Vd: 193 L
Hepatic via CYP3A4; Oral: High first-pass metabolism; forms active and inactive metabolites
Urine (<0.1% as metabolites and unchanged drug)
Onset of Action
Oral: Immediate release: 30 to 60 minutes; Peak effect: 3 to 6 hours; Extended release: Peak effect: 3 days
Time to Peak
Serum: Oral: Immediate release: ~60 minutes; Extended release: 4 to 6 hours; Transdermal: 24 to 48 hours
Duration of Action
Oral: Immediate release: 6 to 10 hours; Extended release: Up to 24 hours; Transdermal 96 hours
IV: ~2 hours (parent drug), 7 to 8 hours (metabolites); Oral: Immediate release: ~2 to 3 hours; Extended release: ~13 hours; Transdermal: 64 hours
>99% primarily to alpha1-acid glycoprotein
Use: Labeled Indications
Overactive bladder: Treatment of symptoms associated with overactive uninhibited neurogenic or reflex neurogenic bladder (eg, urgency, frequency, leakage, urge incontinence, dysuria); treatment of symptoms associated with detrusor overactivity due to a neurological condition (eg, spina bifida) (extended release tablet only).
Hypersensitivity to oxybutynin or any component of the formulation; patients with or at risk for uncontrolled narrow-angle glaucoma, urinary retention, gastric retention or conditions with severely decreased GI motility.
OTC labeling: When used for self-medication, do not use if you have pain or burning when urinating, blood in urine, unexplained lower back or side pain, cloudy or foul-smelling urine; in males; age <18 years; only experience accidental urine loss when cough, sneeze, or laugh; diagnosis of urinary or gastric retention; glaucoma; hypersensitivity to oxybutynin.
Canadian labeling: Additional contraindications (not in US labeling): Severe GI conditions; myasthenia gravis.
Immediate release: 5 mg 2 to 3 times daily; maximum: 5 mg 4 times daily
Extended release: Initial: 5 to 10 mg once daily, adjust dose in 5 mg increments at weekly intervals; maximum: 30 mg once daily
Topical gel: Apply contents of 1 sachet (100 mg/g) or 1 actuation of the pump (100 mg/g) once daily.
Transdermal: Apply one 3.9 mg/day patch twice weekly (every 3 to 4 days)
Oral: Immediate release: Initial: 2.5 mg 2 to 3 times daily; increase cautiously
Topical gel, transdermal patch: Refer to adult dosing.
Neurogenic/Overactive bladder: Oral:
Immediate release: Children: >5 years and Adolescents: 5 mg twice daily; maximum: 5 mg 3 times daily
Extended release: Children ≥6 years and Adolescents: 5 mg once daily; adjust dose as needed in 5 mg increments at weekly intervals; maximum: 20 mg once daily
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.
Oral: Administer without regard to meals. Extended release tablets must be swallowed whole with liquid; do not crush, divide, or chew; take at approximately the same time each day.
Topical gel: For topical use only. Apply to clean, dry, intact skin on abdomen, thighs, or upper arms/shoulders. Rotate application sites; do not apply to the same site on consecutive days. Wash hands after use. Cover treated area with clothing after gel has dried to prevent transfer of medication to others. Do not bathe, shower, or swim until 1 hour after gel applied. Do not apply to recently shaved skin.
Pump: Prior to initial use, prime pump several times (≥ 4 times) until gel begins to come out; after gel is observed, fully depress the pump one more time and discard gel dispensed from pump during priming.
Transdermal: Apply to clean, dry skin on abdomen, hip, or buttock. Select a new site for each new system (avoid reapplication to same site within 7 days). Wear patch under clothing; do not expose to sunlight.
Food causes a slight delay in the absorption of the oral solution and bioavailability is increased by ~25%. Absorption of the extended release tablet is not affected by food. May be taken without regard to meals.
Immediate release tablet and syrup: Store at 20°C to 25°C (68°F to 77°F). Protect from light.
Extended release tablet: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from moisture and humidity.
Topical gel: Store at 20°C to 25°C (68°C to 77°F). Protect from moisture and humidity. Keep away from open flame. Do not store outside the sealed pouch or pump dispenser; apply immediately after removal from the protective pouch or once contents expelled from pump dispenser. Discard used sachets such that accidental application or ingestion by children, pets, or others are avoided.
Transdermal patch: Store at 20°C to 25°C (68°F to 77°F). Protect from moisture and humidity. Do not store outside the sealed pouch; apply immediately after removal from the protective pouch. Discard used patches such that accidental application or ingestion by children, pets, or others is avoided.
AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Alcohol (Ethyl): May enhance the CNS depressant effect of Oxybutynin. Monitor therapy
Amodiaquine: CYP2C8 Inhibitors may increase the serum concentration of Amodiaquine. Avoid combination
Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Oxybutynin. Monitor therapy
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination
Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy
Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Avoid combination
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy
RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
May suppress the wheal and flare reactions to skin test antigens.
Central nervous system: Dizziness (5% to 17%), drowsiness (6% to 14%)
Gastrointestinal: Xerostomia (35% to 71%; dose related), constipation (9% to 15%), nausea (5% to 12%)
1% to 10%:
Cardiovascular: Cardiac arrhythmia (sinus; 1% to <5%), decreased blood pressure (1% to <5%), edema (1% to <5%), flushing (1% to <5%), hypertension (1% to <5%), palpitations (1% to <5%), peripheral edema (1% to <5%)
Central nervous system: Headache (8%), nervousness (7%), insomnia (3% to 6%), confusion (1% to <5%), falling (1% to 5%), fatigue (1% to <5%), flank pain (1% to <5%), pain (1% to <5%)
Dermatologic: Pruritus (1% to <5%), xeroderma (1% to <5%)
Endocrine & metabolic: Fluid retention (1% to <5%), hyperglycemia (1% to <5%), increased thirst (1% to <5%)
Gastrointestinal: Diarrhea (1% to 8%), dyspepsia (5% to 6%), abdominal pain (1% to <5%), dysphagia (1% to <5%), eructation (1% to <5%), flatulence (1% to <5%), unpleasant taste (1% to <5%), vomiting (1% to <5%), gastroesophageal reflux disease (≤1%)
Genitourinary: Urinary hesitancy (2% to 9%), urinary tract infection (7%), urinary retention (1% to 6%), cystitis (1% to <5%), dysuria (1% to <5%), pollakiuria (1% to <5%)
Infection: Fungal infection (1% to <5%)
Neuromuscular & skeletal: Arthralgia (1% to <5%), back pain (1% to <5%), limb pain (1% to <5%), weakness (1% to <5%)
Ophthalmic: Blurred vision (4% to 10%), eye irritation (1% to <5%), keratoconjunctivitis sicca (1% to <5%), xerophthalmia (3%)
Respiratory: Asthma (1% to <5%), bronchitis (1% to <5%), cough (1% to <5%), dry throat (1% to <5%), hoarseness (1% to <5%), nasal congestion (1% to <5%), dry nose (1% to <5%), nasopharyngitis (1% to <5%), pharyngolaryngeal pain (1% to <5%), sinus congestion (1% to <5%), upper respiratory tract infection (1% to <5%)
Gastrointestinal: Xerostomia (8% to 12%)
Local: Application site reaction (6% to 14%; includes anesthesia, irritation, pain, papules)
1% to 10%:
Central nervous system: Dizziness (3%), fatigue (2%), headache (2%)
Dermatologic: Pruritus (1%)
Gastrointestinal: Constipation (1%)
Genitourinary: Urinary tract infection (7%)
Local: Application site erythema (4%), application site rash (3%), application site pruritus (2% to 3%), application site dermatitis (2%)
Ophthalmic: Blurred vision (<2%), xerophthalmia (<2%)
Respiratory: Nasopharyngitis (3%)
>10%: Local: Application site pruritus (14% to 17%)
1% to 10%:
Gastrointestinal: Xerostomia (4% to 10%), constipation (3%), diarrhea (3%)
Genitourinary: Dysuria (2%)
Local: Application site erythema (6% to 8%), application site vesicles (3%), application site rash (3%)
Ophthalmic: Visual disturbance (3%)
Postmarketing and/or case reports (Limited to important or life-threatening): Anaphylaxis, anorexia, cycloplegia, decreased gastrointestinal motility, glaucoma, hallucination, hypersensitivity reaction, impotence, suppressed lactation, memory impairment, mydriasis, psychotic reaction, prolonged Q-T interval on ECG, seizure, tachycardia
Concerns related to adverse effects:
• Angioedema/hypersensitivity reactions: May cause hypersensitivity, including anaphylaxis and angioedema. Cases of angioedema involving the face, lips, tongue, and/or larynx have been reported with oral oxybutynin; some cases have occurred after a single dose. Discontinue immediately if tongue, hypopharynx, or larynx is involved; promptly initiate appropriate management.
• CNS effects: Anticholinergics may cause agitation, confusion, drowsiness, dizziness, hallucinations, headache, somnolence, and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). Dose reduction or discontinuation should be considered if CNS effects occur.
• Heat prostration: May increase the risk of heat prostration.
• Bladder flow obstruction: Use with caution in patients with bladder flow obstruction; may increase the risk of urinary retention.
• Cardiovascular disease: Use with caution in patients with CAD, heart failure, hypertension, and/or cardiac arrhythmias; may exacerbate condition.
• Dementia: Use with caution in patients with dementia treated with cholinesterase inhibitors; may aggravate symptoms of disease.
• GI disorders: Use with caution in patients with decreased GI motility or GI obstructive disorders; may increase the risk of gastric retention. Use with caution in patients with ulcerative colitis, intestinal atony, pyloric stenosis, gastroesophageal reflux, or with medications that may cause or exacerbate esophagitis (eg, bisphosphonates). In patients with ulcerative colitis, use may decrease gastric motility to the point of increasing the risk of paralytic ileus or toxic megacolon.
• Glaucoma: Use with caution in patients with treated angle-closure glaucoma; may exacerbate condition; use is contraindicated with uncontrolled narrow-angle glaucoma.
• Hepatic impairment: Use with caution in patients with hepatic impairment (limited experience).
• Hiatal hernia: Use with caution in patients with hiatal hernia.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism; may exacerbate condition.
• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may exacerbate condition.
• Neuropathy: Use with caution in patients with autonomic neuropathy; may aggravate symptoms of decreased GI motility.
• Parkinson disease: Use with caution in patients with Parkinson disease; may aggravate symptoms of disease.
• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or urinary stricture; may cause urinary retention.
• Renal impairment: Use with caution in patients with renal impairment (limited experience).
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Dosage form specific issues:
• Extended release formulation: The extended release formulation consists of drug within a nondeformable matrix; following drug release/absorption, the matrix/shell is expelled in the stool. The use of nondeformable products in patients with known stricture/narrowing of the GI tract has been associated with symptoms of obstruction (rare).
• Topical gel: To minimize transferring medication to others, cover treatment area with clothing after gel has dried. Discontinue use if skin irritation occurs. Contains ethanol; do not expose to open flame or smoking until gel has dried.
• Transdermal patch: May contain conducting metal (eg, aluminum); remove patch prior to MRI.
• OTC labeling: Other causes of frequent urination (UTI, diabetes, early pregnancy, other serious conditions) may need to be considered prior to use. Patients should contact a health care provider if symptoms do not improve within 2 weeks of initial use or for new or worsening symptoms.
Incontinence episodes, postvoid residual (PVR), anticholinergic reactions.
Pregnancy Risk Factor
Adverse events were not observed in animal reproduction studies.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience blurred vision, diarrhea, nausea, or dry mouth. Have patient report immediately to prescriber severe dizziness, passing out, confusion, hallucinations, agitation, severe fatigue, mood changes, lack of sweat, severe headache, seizures, painful urination, urinary retention, tachycardia, arrhythmia, fast breathing, severe constipation, severe abdominal pain, severe itching, or severe skin irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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