Medically reviewed on Sep 10, 2018
(oks i BYOO ti nin)
- Oxybutynin Chloride
- Oxybutynin Hydrochloride
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 [DSC], 4 ea [DSC], 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 [DSC] [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 bladder (eg, urge urinary incontinence, urgency, frequency, urinary leakage, dysuria); treatment of symptoms associated with overactive bladder due to a neurological condition (eg, spina bifida) in patients ≥6 years (extended release tablet only).
Off Label Uses
Data from randomized, placebo-controlled trials with limited numbers of patients and of short duration suggest that oxybutynin may be beneficial for treatment of primary hyperhidrosis [Schollhammer 2015], [Wolosker 2012]. Additional data may be necessary to further define the role of oxybutynin in this condition.
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); change the patch on the same 2 days each week.
OTC labeling: Females: Apply one 3.9 mg/day patch every 4 days
Primary hyperhidrosis (off-label use): Based on limited data: Oral: Immediate release: Initial: 2.5 mg once daily; gradually titrate per effect and tolerance. Target doses of 7.5 to 10 mg/day in 2 divided doses have been studied (Schollhammer 2015; Wolosker 2012).
Use with caution due to anticholinergic properties (Beers Criteria [AGS 2015]).
Oral: Immediate release: Initial: 2.5 mg 2 to 3 times daily; increase cautiously
Extended release tablets, 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: Extended release tablets: Administer without regard to meals. 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. One full depression of the pump provides one dose; discard after 30 doses.
Transdermal: Apply to clean, dry, smooth (fold-free) skin on abdomen, hip, or buttock; do not apply to areas treated with oils, lotions, or powders. Do not apply to areas with cuts, scrapes, or other irritation (ie, rashes). Do not cut the patch. Apply each system at a new site (avoid reapplication to same site within 7 days). Contact with water while bathing, swimming, showering, or exercising will not change the effect; however, rubbing of the patch area should be avoided during these activities. Patch should be worn 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
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy
Amifampridine: May diminish the anticholinergic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Amifampridine. 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. Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. 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. Monitor therapy
OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy
Opioid Analgesics: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Analgesics. Specifically, the risk for constipation and urinary retention may be increased with this combination. 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
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. 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 concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of 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 72%), constipation (9% to 15%), nausea (5% to 12%)
1% to 10%:
Cardiovascular: Decreased blood pressure (1% to <5%), edema (1% to <5%), flushing (1% to <5%), increased blood pressure (1% to <5%), palpitations (1% to <5%), peripheral edema (1% to <5%), sinus arrhythmia (1% to <5%)
Central nervous system: Headache (8%), nervousness (7%), insomnia (3% to 6%), confusion (1% to <5%), falling (1% to <5%), fatigue (3%), flank pain (1% to <5%), pain (1% to <5%)
Dermatologic: Xeroderma (2% to 3%), pruritus (1% to 2%)
Endocrine & metabolic: Fluid retention (<5%), increased thirst (<5%), increased serum glucose (1% to <5%)
Gastrointestinal: Diarrhea (7% to 8%), dyspepsia (5% to 6%), coated tongue (1% to <5%), eructation (1% to <5%), upper abdominal pain (1% to <5%), flatulence (1% to 3%), abdominal pain (2%), dysgeusia (2%), vomiting (1% to 2%), gastroesophageal reflux disease (≤1%)
Genitourinary: Urinary hesitancy (2% to 9%), urinary tract infection (7%), urinary retention (1% to 6%), cystitis (1% to <5%), pollakiuria (1% to <5%), increased post-void residual urine volume (2% to 4%), dysuria (2%)
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: Dry nose (2% to 5%), asthma (1% to <5%), bronchitis (1% to <5%), hoarseness (1% to <5%), nasal congestion (1% to <5%), nasopharyngitis (1% to <5%), pharyngolaryngeal pain (1% to <5%), sinus congestion (1% to <5%), sinus headache (1% to <5%), upper respiratory tract infection (1% to <5%), cough (2% to 3%), dry throat (2% to 3%), oropharyngeal pain (2%)
1% to 10%:
Central nervous system: Dizziness (3%), fatigue (2%), headache (2%)
Dermatologic: Pruritus (1%)
Gastrointestinal: Xerostomia (8%), viral gastroenteritis (2%), constipation (1%)
Genitourinary: Urinary tract infection (7%)
Local: Application site reaction (5%), application site dermatitis (2%), application site pruritus (2%),
Respiratory: Upper respiratory tract infection (5%), nasopharyngitis (3%)
>10%: Local: Application site pruritus (14% to 17%)
1% to 10%:
Dermatologic: Macular eruption (application site: 3%)
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%)
<1%, postmarketing, and/or case reports: Agitation, anaphylaxis, angioedema, anorexia, cardiac arrhythmia, chest discomfort, confusion, cycloplegia, decreased gastrointestinal motility, decreased lactation, delirium, dizziness, drowsiness, dysphagia, facial edema, frequent bowel movements, glaucoma, hallucination, headache, hot flash, hypersensitivity reaction, hypertension, hypohidrosis, impotence, memory impairment, mydriasis, prolonged Q-T interval on ECG, psychotic reaction, seizure, skin rash, tachycardia, urticaria, voice disorder
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: Avoid use in patients with myasthenia gravis; may exacerbate condition. Discontinue therapy if signs/symptoms occur.
• 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 (eg, dry mouth, constipation, dizziness).
Pregnancy Risk Factor
Adverse events were not observed in animal reproduction studies.
Information related to the use of oxybutynin in patients treated for neurogenic bladder during pregnancy is limited (Andretta 2018).
• 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, anxiety, insomnia, application site redness, or dry mouth. Have patient report immediately to prescriber signs of a urinary tract infection (hematuria, burning or painful urination, polyuria, fever, lower abdominal pain, or pelvic pain), severe dizziness, passing out, confusion, hallucinations, agitation, severe fatigue, mood changes, lack of sweat, severe headache, seizures, urinary retention, tachycardia, abnormal heartbeat, fast breathing, severe constipation, severe abdominal pain, muscle weakness, 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 health care 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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