How does oxybutynin work for overactive bladder. What are the common side effects of oxybutynin. How long does it take for oxybutynin to start working. Who can take oxybutynin and who should avoid it. What are the different forms and dosages of oxybutynin.

Understanding Oxybutynin: A Medication for Overactive Bladder

Oxybutynin is a prescription medication used to treat symptoms associated with overactive bladder. These symptoms can significantly impact a person’s quality of life and include:

• Sudden and urgent need to urinate (urinary urgency)
• Frequent urination (urinary frequency)
• Urinary incontinence (involuntary leakage of urine)

Additionally, oxybutynin is prescribed to manage bedwetting in children, a condition known as nocturnal enuresis. The medication works by relaxing the muscles surrounding the bladder, which allows it to hold more liquid and reduces the frequency and urgency of urination.

How Oxybutynin Works: Mechanism of Action

Oxybutynin belongs to a class of medications called anticholinergics. Its primary mechanism of action involves blocking the effects of acetylcholine, a neurotransmitter that stimulates bladder contractions. By inhibiting these contractions, oxybutynin helps to:

• Increase bladder capacity
• Reduce involuntary bladder contractions
• Delay the initial urge to urinate

This results in improved bladder control and a reduction in overactive bladder symptoms. Can oxybutynin completely cure overactive bladder. While oxybutynin can significantly improve symptoms, it is not a cure for overactive bladder. Rather, it helps manage the condition by addressing the underlying muscle activity that contributes to the symptoms.

Available Forms and Dosages of Oxybutynin

Oxybutynin is available in several forms, each with its own dosage recommendations:

Standard Tablets (Immediate Release)

These tablets come in strengths of 2.5mg, 3mg, or 5mg. The typical starting dose is:

• 2.5mg taken twice daily (morning and evening)
• Or 2.5mg taken three times daily

Slow-Release Tablets (Prolonged Release)

Available in 5mg and 10mg strengths, with a usual starting dose of 5mg once daily.

Liquid Form

Oxybutynin liquid is particularly useful for children and those who have difficulty swallowing tablets. It comes in two concentrations:

• 2.5mg of oxybutynin per 5ml
• 5mg of oxybutynin per 5ml

The standard adult starting dose is typically 5mg taken twice daily or 5mg taken three times daily.

Transdermal Patches

Oxybutynin patches are applied to the skin twice a week, offering a consistent release of medication over time.

Proper Administration and Usage Guidelines

To ensure maximum effectiveness and minimize side effects, it’s crucial to follow proper administration guidelines for oxybutynin:

Standard Tablets

Swallow whole with water, with or without food. If taking multiple doses per day, space them evenly throughout the day.

Slow-Release Tablets

Swallow whole with water. Do not break, crush, or chew these tablets, as it may affect the controlled release mechanism.

Liquid Form

Use the provided measuring device to ensure accurate dosing. For children using it for bedwetting, administer the last dose just before bedtime.

Patches

Apply to clean, dry skin on the stomach, hip, or buttocks. Change patches twice weekly, rotating application sites to minimize skin irritation.

Is it necessary to take oxybutynin at the same time each day. For optimal results and to establish a routine, it’s advisable to take oxybutynin at consistent times each day, especially for the slow-release formulations.

Onset of Action: How Long Does Oxybutynin Take to Work?

One of the most common questions patients have is how quickly they can expect to see results from oxybutynin. The onset of action can vary depending on several factors:

• Individual patient response
• Severity of symptoms
• Dosage and form of oxybutynin used

Generally, patients may notice some improvement in symptoms within the first week of treatment. However, it can take up to 4 weeks for oxybutynin to reach its full effect. If symptoms do not improve after 1 to 2 weeks, it’s important to consult with your healthcare provider.

Do all patients respond to oxybutynin in the same timeframe. No, individual responses can vary significantly. Some patients may experience rapid improvement, while others may require more time to see noticeable effects.

Follow-up and Monitoring

To ensure the medication is working effectively and remains the best treatment option, healthcare providers typically:

• Conduct a review after 4 weeks of treatment
• Perform regular check-ups every 6 to 12 months

These follow-ups allow for dosage adjustments if necessary and help identify any potential side effects or changes in the patient’s condition.

Side Effects and Precautions

Like all medications, oxybutynin can cause side effects. Common side effects include:

• Dry mouth
• Blurred vision
• Constipation
• Dizziness
• Drowsiness

Can these side effects be managed. Many side effects can be mitigated through proper hydration, dietary adjustments, and in some cases, dosage modifications under medical supervision.

Alcohol Interaction

It’s advisable to avoid alcohol when first starting oxybutynin treatment, as it can exacerbate the drowsiness side effect.

Special Precautions

Certain conditions may require special consideration before using oxybutynin:

• Myasthenia gravis
• Glaucoma
• Urinary retention or enlarged prostate
• Ulcerative colitis or Crohn’s disease
• Heart conditions
• Thyroid, kidney, or liver problems

Is oxybutynin safe for long-term use. While oxybutynin can be used long-term under medical supervision, regular check-ups are essential to monitor its ongoing effectiveness and safety.

Who Can Take Oxybutynin: Eligibility and Contraindications

Oxybutynin is generally prescribed for:

• Adults with overactive bladder symptoms
• Children aged 5 years and older, particularly for managing bedwetting

However, certain groups should avoid oxybutynin or use it with caution:

Contraindications

Oxybutynin should not be used by individuals with:

• Known allergies to oxybutynin or its ingredients
• Certain types of glaucoma
• Complete urinary retention
• Severe gastrointestinal conditions like toxic megacolon

Use with Caution

Special care should be taken in patients with:

• Partial urinary obstruction
• Gastrointestinal obstructive disorders
• Autonomic neuropathy
• Severe hepatic or renal impairment

Can pregnant or breastfeeding women take oxybutynin. The use of oxybutynin during pregnancy and breastfeeding should be carefully evaluated by a healthcare provider, weighing the potential benefits against possible risks.

Adjusting Oxybutynin Dosage: When and Why

Dosage adjustments may be necessary to optimize treatment efficacy and minimize side effects. Your healthcare provider may consider increasing your dose if:

• Symptoms are not adequately controlled after the initial treatment period
• The current dose is well-tolerated but not fully effective

Conversely, dose reductions might be considered if:

• Side effects are troublesome or persistent
• Symptoms have significantly improved and a lower dose may suffice

Is it safe to adjust oxybutynin dosage without consulting a healthcare provider. No, all dosage changes should be made under the guidance of a healthcare professional to ensure safety and effectiveness.

Individualized Treatment Approach

The goal of oxybutynin therapy is to find the lowest effective dose that provides symptom relief with minimal side effects. This often involves a process of careful titration and monitoring.

Alternatives to Oxybutynin: Exploring Other Treatment Options

While oxybutynin is an effective treatment for many patients with overactive bladder, it’s not the only option available. Alternative treatments include:

Other Medications

• Other anticholinergics (e.g., tolterodine, solifenacin)
• Beta-3 agonists (e.g., mirabegron)
• Tricyclic antidepressants for certain types of incontinence

Non-Pharmacological Approaches

• Pelvic floor exercises (Kegels)
• Bladder training techniques
• Dietary modifications
• Weight loss (if applicable)

Advanced Therapies

• Botulinum toxin injections
• Sacral nerve stimulation
• Percutaneous tibial nerve stimulation

How do these alternatives compare to oxybutynin in terms of efficacy. The effectiveness of alternative treatments can vary widely among individuals. Some patients may find greater success with other options, while others respond best to oxybutynin. A healthcare provider can help determine the most suitable treatment based on individual factors and symptoms.

Managing Overactive Bladder: A Holistic Approach

While medication like oxybutynin plays a crucial role in managing overactive bladder symptoms, a comprehensive treatment plan often incorporates multiple strategies:

Lifestyle Modifications

• Fluid management: Balancing hydration without overloading the bladder
• Avoiding bladder irritants: Reducing intake of caffeine, alcohol, and spicy foods
• Scheduled voiding: Training the bladder to urinate at regular intervals

Physical Therapy

Working with a pelvic floor physical therapist can help strengthen the muscles that support bladder control.

Behavioral Techniques

• Double voiding: Urinating twice in quick succession to ensure complete bladder emptying
• Urge suppression techniques: Methods to control sudden urges to urinate

Can lifestyle changes alone be sufficient to manage overactive bladder. In some cases, particularly for mild symptoms, lifestyle modifications and behavioral techniques may provide significant relief without the need for medication. However, many patients benefit from a combination of approaches, including medication like oxybutynin.

Long-Term Outlook: Living with Overactive Bladder

Managing overactive bladder is often a long-term process. While treatments like oxybutynin can provide significant symptom relief, it’s important to maintain ongoing communication with healthcare providers and adapt treatment strategies as needed.

Monitoring Progress

Keeping a bladder diary can help track symptom improvements and identify any patterns or triggers that may affect bladder control.

Addressing Quality of Life

Overactive bladder can impact various aspects of life, including:

• Sleep quality
• Social interactions
• Work productivity
• Emotional well-being

A comprehensive treatment plan should address these areas to improve overall quality of life.

Ongoing Research

The field of urology continues to evolve, with new treatments and management strategies emerging. Staying informed about the latest developments can help patients and healthcare providers make informed decisions about long-term care.

Is it possible to completely overcome overactive bladder. While complete resolution of symptoms is not always achievable, many patients experience significant improvements in bladder control and quality of life with proper treatment and management strategies.

Conclusion: Empowering Patients with Knowledge

Understanding oxybutynin and its role in managing overactive bladder is crucial for patients and caregivers alike. By knowing how the medication works, what to expect in terms of onset and effects, and how to properly administer it, patients can take an active role in their treatment journey.

Remember that overactive bladder management is often a multifaceted approach, combining medication with lifestyle changes and other therapeutic strategies. Regular communication with healthcare providers, patience during the treatment process, and a willingness to explore various management techniques can lead to improved symptoms and enhanced quality of life.

As with any medical condition, personalized care is key. What works best for one individual may not be ideal for another. By working closely with healthcare professionals and staying informed about treatment options, patients with overactive bladder can find the most effective path to managing their symptoms and regaining control over their daily lives.

Oxybutynin – a medicine for treating symptoms of an overactive bladder

1. About oxybutynin

Oxybutynin is a medicine used to treat symptoms of an overactive bladder. These can include:

• a sudden and urgent need to pee (urinary urgency)
• needing to pee more often than usual (urinary frequency)
• wetting yourself if you cannot make it to the loo in time (urinary incontinence)

It’s also used to treat bedwetting in children (nocturnal enuresis).

Oxybutynin works by relaxing the muscles around your bladder. This means your bladder can hold more liquid and you do not need to pee as often or as urgently.

Oxybutynin is only available on prescription.

It comes as standard tablets for immediate release, or slow-release tablets (also called prolonged release), a liquid to swallow, or as patches.

2. Key facts

• Oxybutynin may take up to 4 weeks to reach its full effect. If the symptoms do not improve after 1 to 2 weeks, talk to your doctor.
• Your doctor will do a review after 4 weeks to check oxybutynin is still working and is the best treatment for you.
• Your doctor will also check that your treatment is still needed every 6 to 12 months .
• Common side effects of oxybutynin include dry mouth, blurred vision, constipation and feeling dizzy or sleepy.
• It’s best not to drink alcohol when you first start taking oxybutynin, as it can make you very sleepy.

3. Who can and cannot take oxybutynin

Oxybutynin can be taken by adults and children aged 5 years or over.

Oxybutynin is not suitable for some people. To make sure it’s safe for you, tell your doctor before starting oxybutynin if you have:

• ever had an allergic reaction to oxybutynin, any of its ingredients or any other medicine
• myasthenia gravis, a rare long-term condition that causes muscle weakness
• an eye problem called glaucoma
• difficulty peeing, or an enlarged prostate
• ulcerative colitis or Crohn’s disease
• heart problems, including a very fast heart rate or high blood pressure
• thyroid, kidney or liver problems

4.

How and when to take oxybutynin

Always read the information that comes with your medicine.

Dosage and strength of standard tablets

Standard tablets come as either 2.5mg, 3mg or 5mg.

The usual starting dose of 2.5mg is 1 tablet, taken twice a day, in the morning or evening, or 1 tablet, taken 3 times a day.

If you take 3 doses a day, space each dose evenly throughout the day. You could take it first thing in the morning, in the middle of the afternoon and at bedtime.

Dosage and strength of slow-release tablets

Slow-release tablets come in 2 strengths, 5mg and 10mg. The usual starting dose is 5mg once a day.

Dosage and strength of liquid

Oxybutynin is available as a liquid for children and people who find it difficult to swallow tablets. It comes in 2 strengths:

• 2.5mg of oxybutynin in a 5ml spoonful
• 5mg in oxybutynin in a 5ml spoonful

The usual starting dose for an adult is 5mg, taken twice a day (12 hours apart), or 5mg, taken 3 times a day.

The dose will usually be lower for adults over 65 and children.

If you take 3 doses a day, space each dose evenly throughout the day. You could take it first thing in the morning, in the middle of the afternoon and at bedtime.

How to take standard tablets

Swallow the tablets whole with a drink of water. You can take tablets with or without food.

How to take slow-release tablets

Slow-release tablets release oxybutynin slowly and evenly throughout the day.

Swallow these tablets whole with a drink of water. Do not break, crush or chew them.

Try to take your tablet at the same time each day. This will help you to remember to take them.

Part of the tablet can pass through your body and you might see it in your poo. Do not worry, this is normal and does not affect the way the medicine works.

How to take liquid

If you are giving this medicine to a child to help stop them wetting the bed, give the last dose just before bedtime.

Oxybutynin liquid will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount of medicine.

How to use patches

Oxybutynin patches are applied twice a week.

They work like a plaster., you stick them to your skin.

1. Follow the instructions that come with the patches.
2. Stick a patch to clean, dry skin on your stomach, hip or bottom twice a week (every 3 or 4 days).
3. Change the patch on the same 2 days every week, such as every Sunday and Wednesday, or Monday and Thursday.
4. Remove the old patch before sticking on the new one.
5. Stick the new patch to a different area of your stomach, hips or bottom. Using the same area may irritate your skin. Do not stick the patch in the same place for at least 1 week.

Will my dose go up or down?

Your doctor may increase your dose depending on how the medicine works for you.

What if I forget to take it?

If you forget to take a dose, take it as soon as you remember, unless it’s almost time for your next dose. In this case, just skip the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.

What if I take too much?

Taking 1 extra dose of oxybutynin is unlikely to harm you.

However, you may get more side effects, such as a dry mouth or headache.

The amount of oxybutynin that can lead to an overdose varies from person to person, and too much oxybutynin can be dangerous.

Urgent advice: Contact 111 for advice now if:

You take 2 or more extra doses of oxybutynin and you:

• have hallucinations
• feel very restless or excited
• have dilated pupils in your eyes
• are not able to pee

Call 111 or go to 111. nhs.uk

If you need to go to hospital, do not drive yourself. Get someone else to drive you, or to call you an ambulance.

Take the oxybutynin packet with you, or the leaflet inside it, plus any remaining medicine.

Immediate action required: Call 999 or go to A&E if:

You take more than your usual dose of oxybutynin and you have:

• a fast heartbeat
• breathing problems

5. Side effects

Like all medicines, oxybutynin can cause side effects, but not everyone gets them.

Keep taking oxybutynin, but talk to your doctor or pharmacist if these side effects bother you or do not go away, or if you notice any other possible side effects.

Common side effects of oxybutynin

These common side effects of oxybutynin may affect more than 1 in 100 people:

• dry mouth
• headache
• feeling dizzy, sleepy, or a spinning sensation (vertigo)
• diarrhoea or being sick (vomiting)
• constipation
• farting and burping (wind)
• stomach pain
• dry eyes
• blurred vision
• problems or pain when peeing, and not being able to empty your bladder

Serious side effects

Serious side effects are rare.

Tell your doctor if you have:

• stomach pain (especially after meals), feeling sick or being sick, a persistent urge to poo, not being able to poo or you have runny poos – these are all signs of faecal impaction, where large, hardened poo gets stuck and you cannot push it out
• difficulty fully emptying your bladder, or difficulty in starting to pee – these are signs of urinary retention, where pee builds up in your bladder because you’re unable to pee
• high temperature or chills, burning sensation when peeing, pain in your back or side, or bloody or cloudy pee – these can be signs of a severe urinary tract infection (UTI)
• swollen ankles or legs (oedema) – where fluid builds up in your legs

Do not take any more oxybutynin and call a doctor straight away if you feel you’re overheating and not sweating when you’re in hot surroundings.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to oxybutynin.

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of oxybutynin. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of oxybutynin

What to do about:

• dry mouth – try sugar-free gum or having sugar-free sweets. Having a dry mouth can cause tooth decay or a fungal infection. It also might stop medicine that you put under your tongue from dissolving properly, such as medicine for angina.
• headaches – make sure you rest and drink plenty of fluids. Avoid alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if your headache is severe or lasts longer than 1 or 2 days.
• feeling dizzy, sleepy or a spinning sensation – do not drive, cycle, use tools, or operate machinery. Avoid drinking alcohol, as this may make your symptoms worse. Talk to your doctor if the dizziness or sleepiness bothers you or lasts more than a few days.
• diarrhoea or being sick – drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you’re being sick. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines without speaking to a pharmacist or doctor, if the effects last more than 1 or 2 days.
• constipation – eat more high-fibre foods, such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to a pharmacist or doctor. Watch this short video about how to treat constipation.
• farting and burping – eat less foods that cause wind, like lentils, peas, beans and onions. It might also help to eat smaller and more frequent meals, eat and drink slowly, and exercise regularly. Ask your pharmacist about remedies you can buy to help with trapped wind.
• stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Try putting a heat pad or a covered hot water bottle on your stomach to help. If you have episodes of severe, griping pain, speak to your pharmacist or doctor.
• dry eyes – ask your pharmacist or optician to recommend some eye drops. If you wear contact lenses and these become uncomfortable, you might have to wear glasses instead while you’re taking this medicine.
• blurred vision – do not drive or cycle until you can see clearly again. Do not take your next dose of oxybutynin if your vision is still blurred. Speak to your doctor or pharmacist if your vision has not returned to normal a day after taking your last dose.
• problems or pain when peeing – try to relax when you pee. Do not try to force the flow of urine. If it does not happen, try again later. Talk to a doctor urgently if you cannot pee at all.

7. Pregnancy and breastfeeding

Oxybutynin and pregnancy

Oxybutynin is occasionally used in pregnancy when bladder symptoms are severe and cannot be controlled any other way.

If you’re pregnant or trying to get pregnant, talk to your doctor about whether taking oxybutynin is right for you.

Oxybutynin and breastfeeding

Oxybutynin is not usually recommended while breastfeeding. However, you may still need to take it.

It’s not known how much oxybutynin gets into breast milk, but it’s likely to be small.

If your doctor says it’s OK for you to keep taking oxybutynin, monitor your baby for possible side effects, such as constipation, peeing less and colic.

Talk to your doctor, midwife, or health visitor if you have any concerns about your baby, or you do not think your baby is putting on enough weight.

Non-urgent advice: Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

For more information about treating bladder problems (urinary incontinence) during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPs) website.

8. Cautions with other medicines

Oxybutynin may affect the way other medicines work, and other medicines may affect how oxybutynin works.

Tell your pharmacist or doctor if you’re taking:

• amantadine, a medicine used for Parkinson’s disease or for infections
• levodopa, used to treat Parkinson’s disease
• phenothiazines, clozapine, haloperidol or benperidol, medicines for mental health problems
• donepezil, rivastigmine, galantamine or tacrine, medicines used for dementia
• amitriptyline, imipramine or dosulepin (tricyclic antidepressants), medicines for depression
• medicines used to make you feel sleepy (sedatives)
• anti-sickness medicines like prochlorperazine
• medicines for stomach and bowel-related problems like domperidone and metoclopramide
• digoxin, quinidine or disopyramide, medicines used to treat heart problems
• dipyridamole, used to treat blood problems
• chlorphenamine or diphenhydramine, medicines used to treat allergies
• any medicines used to treat irritable bowel syndrome, asthma, incontinence, motion sickness or movement disorders related to Parkinson’s disease, that work in a similar way to oxybutynin

Mixing oxybutynin with herbal remedies and supplements

There’s very little information about taking oxybutynin with herbal remedies and supplements. These remedies are not tested in the same way as medicines.

Some herbal medicines can make you feel sleepy, cause a dry mouth, or make it difficult to pee. Their effect is similar to oxybutynin. This can increase your risk of getting side effects or make your side effects worse.

Important:
Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about oxybutynin

How does oxybutynin work?

Oxybutynin is a type of medicine called an antimuscarinic (or anticholinergic) muscle relaxant.

It works by relaxing the muscle that is found in the wall of the bladder. This helps to increase the volume of pee your bladder can hold and control the release of pee.

How long does it take to work?

Oxybutynin starts to work after about 3 to 4 hours to relax the muscle surrounding your bladder.

However it may take up to 4 weeks before it works fully.

If your symptoms do not start to get better after 7 days talk to your doctor.

Talk to your doctor if your symptoms get worse at any time.

How long will I take it for?

Usually, you’ll need to take oxybutynin for a long time.

After 4 weeks your doctor will check that oxybutynin is helping your symptoms. They’ll also do a review every 6 to 12 months after that to check it’s still working for you.

Take oxybutynin until your doctor tells you to stop. Do not stop taking it just because you feel better.

Is it safe to take for a long time?

There may be an increased risk of confusion and possibly dementia in people taking oxybutynin, but more study needs to be done. If you’re worried about this, talk to your doctor.

Do not take oxybutynin for longer than you need to. Your doctor will check every 6 to 12 months that your treatment is still needed.

Is it safe to take with painkillers?

It’s safe to take oxybutynin with everyday painkillers like paracetamol and ibuprofen.

What will happen if I stop taking it?

If you’ve been taking oxybutynin for at least 6 months your doctor may suggest that you stop taking the medicine for up to 4 weeks to see how your symptoms change without it.

Some people find that the improvement in their symptoms continues after the medicine has been stopped. Talk to your doctor if you’re thinking about stopping your medicine.

Do not stop taking oxybutynin without talking to your doctor first.

Are there other medicines for urinary incontinence and overactive bladder?

Oxybutynin belongs to a group of medicines called antimuscarinics. There are other antimuscarinics that can be used for overactive bladder:

• solifenacin
• tolterodine
• darifenacin
• fesoterodine
• propiverine
• trospium

They all seem to work just as well as oxybutynin. However, if you get side effects with one antimuscarinic a different one may suit you better.

If antimuscarinics are unsuitable for you, they have not helped your overactive bladder, or you have had side effects, you may be offered a medicine called mirabegron, which works in a slightly different way.

Can I drink alcohol with it?

Try to avoid drinking alcohol when you first start taking oxybutynin, or if your dose is increased, to see how you feel. Oxybutynin combined with alcohol can make you feel very sleepy.

Drinking alcohol may make you more likely to need to get up in the night to pee.

Is there any food or drink I need to avoid?

You can eat normally while taking oxybutynin. If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee and cola.

Will I gain or lose weight?

Oxybutynin can make you feel less hungry, so you may lose weight.

If you start to have problems with your weight while taking oxybutynin, talk to your doctor or pharmacist.

Will it affect my contraception?

Oxybutynin does not stop contraceptive pills working, including the combined pill or emergency contraception.

However, if oxybutynin makes you sick or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.

Read more about what to do if you’re on the pill and you’re being sick or have diarrhoea.

Will it affect my fertility?

There’s no clear evidence to suggest that taking oxybutynin will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor before taking it if you’re trying to get pregnant.

Can I drive or ride a bike?

Do not drive a car, ride a bike, use tools or operate machinery if oxybutynin makes you sleepy, gives you blurred vision, or makes you feel dizzy, clumsy or unable to concentrate or make decisions.

This may be more likely when you first start taking it, but it could happen at any time, such as when you increase the dose or start another medicine.

Talk to a doctor or pharmacist if you’re not sure whether it’s safe for you to drive while taking oxybutynin.

Are there lifestyle changes that can help overactive bladder?

There are a number of lifestyle changes that may help your symptoms. It’s a good idea to:

• cut back on drinks that contain caffeine, such as tea, coffee and cola, as caffeine can increase how much you pee
• not drink too much or too little fluid during the day, as this can make incontinence worse
• lose weight if you are overweight or obese, as being overweight can increase your risk of urinary incontinence – use the BMI healthy weight calculator to find out if you’re a healthy weight for your height
• try pelvic floor muscle training (Kegel exercises)
• try bladder training
• discuss other options for urinary incontinence with your doctor, such as surgery and procedures

Oxybutynin (Ditropan, Lyrinel XL) | MS Trust

Oxybutynin is used in the treatment of bladder symptoms when you need to go to the toilet urgently or frequently.

Oxybutynin is taken by mouth (orally) as tablets, the dose and number of times a day you take the tablets will be decided by your doctor, but it is usually between two and four times a day. It can be taken before, during or after a meal.

You may not see an immediate effect when you first start taking oxybutynin. Your bladder will need some time to adapt. It usually starts to have an effect within four weeks. Oxybutynin can affect the amount of urine that stays in your bladder and monitoring this before starting on medication is important. It is normal for a small amount to be retained, but the risk of urinary tract infections (UTIs) is increased if too much urine remains in the bladder.

Results vary from person to person, and often depend on how severe your symptoms were initially.

If tolerated the medication should be taken for a month so your doctor can assess how effective the treatment is for you. You should then be reassessed again after a few months. If there is no noticeable improvement the medication should be stopped.

The side effects from oxybutynin can include:

• dry mouth
• headache
• dry eyes
• constipation
• hot flushes or facial flushing

Sucking sugar free sweets or ice cubes, or chewing sugarless gum can help alleviate a dry mouth. Saliva substitutes can also help, these can be purchased over the counter in pharmacies.

Dry eyes only usually occur for a short period, but using eye drops may help if this is a problem.

If you experience headache, initially you could try taking paracetamol regularly.

If constipation is an issue, try to make sure you’re drinking plenty of fluids – around eight cups per day is recommended. A mild laxative, such as Sennakot, may help over the initial period. Also increasing the amount of soluble fibre in your diet, such as oats and oat bran, beans and peas, barley, rye and flax seed, or fruit such as bananas, pears and apples, and root vegetables (preferably without the skins), can help.

Ensuring your room is well ventilated, and wearing cotton nightwear and using cotton bedsheets, can help reduce the effects of hot flushes and facial flushing.

Oxybutynin isn’t recommended if you’re pregnant or breastfeeding. You shouldn’t take this medication if you’re being treated for glaucoma until it’s established whether you have wide or narrow angle glaucoma and it’s been confirmed it’s safe for you to take.

Oxybutynin can also have an effect on cognition and may lead to confusion.

You should avoid or stop taking this medication if you:

• experience changes in your vision
• have severe abdominal pain or cramps
• cannot pass urine or find it difficult to urinate
• experience a new onset of lower back pain
• experience palpitations
• feel dizzy or faint
• notice changes in your cognitive function or experience increased confusion.

You should stop taking oxybutynin immediately if you experience swelling of the face or tongue and a rash, and consult the person who prescribed the medication.

Oxybutynin is a type of drug called an anticholinergic. These drugs block the action of the neurotransmitter (chemical messenger) acetylcholine, which transfers messages including those that start bladder contractions. It is used to try and reduce how frequently you need to empty your bladder, the sensation of urgently needing to go to the toilet and urinary incontinence. Day and night-time leaks should reduce or even stop completely.

Oxybutynin is also classed as an antispasmodic, so it also works to relax the muscles of the bladder wall, which in turn helps improve your ability to control your bladder.

Overactive bladder. Medical therapy

Transcript of the lecture

XXV All-Russian Educational Internet Session for doctors

Total duration: 24:23

00:00

Oksana Mikhailovna Drapkina, Secretary of the Interdepartmental Scientific Council for Therapy of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor:

We’re moving on to the next section. We move from hepatology to urology. Professor Shkolnikov Maxim Evgenievich: “Overactive bladder. Medical Therapy”.

Maxim Evgenyevich Shkolnikov, professor:

– Good afternoon, dear colleagues! Today we will return to the common topic of an overactive bladder.

You see on this slide: according to epidemiological studies, overactive bladder occurs in 10% to 15% of the world’s population. With age, its frequency increases.

The very problem of an overactive bladder occurs and disrupts the function of the lower urinary tract, namely the phase of accumulation of urine. All the symptoms that occur in this situation occur when urine accumulates in the bladder. It is very important that the bladder maintains low pressure at this point so that it can store enough urine. When this does not happen, this condition may occur.

According to modern terminology, the leading symptom of an overactive bladder is urgency. It consists in the feeling of a sudden, formidable urge to urinate, which is difficult to contain. Often this symptom is also accompanied by frequent urination, as well as urinary incontinence.

An overactive bladder is thought to be caused by detrusor overactivity. This, in turn, is already a urodynamic concept. It consists of an involuntary contraction of the detrusor during the accumulation phase of urine.

The main mechanism of detrusor smooth muscle contraction is associated with the presence of muscarinic receptors, the activation of which leads to the contraction of smooth myocytes. The main contractile function is performed by M3 receptors, which lead to contraction, but M2 receptors also play a role. They block the relaxation mechanism of smooth myocytes activated by ?3 adrenoreceptors.

02:39

Today, there is talk of involvement of other structures in the bladder wall, which can also lead to some of the symptoms of an overactive bladder.

Urothelium. You see on this slide: it contains a huge number of different receptors that respond to chemical and physical stimuli. It can also release a number of neurotransmitters (acetylcholine, nitric oxide, ATP), which affect and modulate the activity of detrusor smooth myocytes, and can also lead to the activation of peripheral nerve fibers. They, in turn, can lead to the emergence of the very symptom of urgency.

In addition, a certain role is assigned to interstitial cells located in the suburothelial space. They have certain electrical properties and contain a number of receptors, the activation of which can lead to the generation of an electrical signal, its amplification and transmission to sensory fibers, which is perceived by the central nervous system as a desire to urinate.

This slide summarizes a huge number of drugs. This is from the International Consultation on Urinary Incontinence. They are based on the principles of evidence-based medicine. You see that the only drugs that are clearly, with proven efficacy for bladder symptoms, are (single class) the antimuscarinic drugs.

There are also drugs such as Oxybutynin and Propiverin, which have a mixed effect. Their antimuscarinic effect is combined with a direct antispasmodic effect.

Another drug with I A level of evidence. This is “Desmopressin”, which refers to analogues of vasopressin.

All other groups of drugs, namely ?-blockers, ?-adrenergic agonists, NSAIDs, have not yet acquired a sufficient evidence base so that we can clearly and boldly recommend them for the treatment of patients with symptoms of an overactive bladder.

05:17

So, today in Russian pharmacies we can purchase the following antimuscarinic drugs.

Oxybutynin. Surely all specialists who deal with the problem of an overactive bladder, a well-known drug. It has been on the market since about the 1960s. A very old drug. Used as a comparison tool for new developments. But, looking ahead, I will say that this is the most toxic of all drugs on the market today.

Trospium chloride. Also quite an old drug, but proven to be highly effective. Looking ahead, I will say that he has quite a few unusual, unique features that make it possible to distinguish him from the entire group of antimuscarinic drugs.

Tolterodine. To date, the Russian market exists exclusively in the form of a generic.

Solifenacin. New drug (relatively new). He also performed well. We are waiting for new data regarding the effectiveness of this drug in different patients, patients.

Although M3 receptors are central to the mechanism of bladder contraction, they are in the minority compared to M2 receptors in the detrusor wall. Approximately it makes 2:3. There is evidence that conditions such as diabetes mellitus, neurological disease, infrarenal obstruction, and age-related changes contribute to the fact that M2 receptors increase even more compared to M3 receptors.

What should be the ideal antimuscarinic drug? First, it should have maximum affinity for M2 and M3 receptors. It should have maximum uroselectivity, that is, exert its effect exclusively on the lower urinary tract, because everyone knows that muscarinic receptors are also located in other smooth muscle organs, as well as the salivary glands and the brain. Exposure to them can cause a number of practically unacceptable side effects.

The drug should not affect other drugs, so as not to change their pharmacokinetics and pharmacodynamics.

Finally, the drug should be easy to apply. Ideally, once a day, so that, as they say, drink and forget.

08:35

Among the drugs on the market regarding their affinity for muscarinic receptors, you see that trospium chloride (or spasmex) has the highest affinity for all types of muscarinic receptors.

If we talk directly about M3 and M2 receptors, then all drugs can be divided into three main groups. These are equivalent drugs: with the same tropism for M2 and M3. Relatively selective M3 drugs. Superselective M3 drugs.

Trospium chloride, tolterodine are relatively equivalent drugs. You see that equivalent tropism is when their ratio is one. In trospium chloride it is 1.3, in tolterodine 3.2.

Solifenacin, oxybutynin are relatively selective drugs.

Finally, darifenacin, which is not yet on the market (in the research phase), belongs to the superselective M3 receptors.

To date, the debate about whether M3 selectivity is an advantage or vice versa has not subsided, because, unfortunately, there are no direct comparative studies yet.

The next point by which antimuscarinic drugs can be compared. Their chemical structure. You see that most of them, and you can say almost all of them with the exception of trospium chloride, are amine derivatives and have three nitrogen bonds. Unlike trospium chloride, which has four bonds and a charged nitrogen atom.

Such physico-chemical properties of the drug allow trospium chloride, unlike other agents, to practically not penetrate into the central nervous system. Moreover, there is evidence that a special glycoprotein exists in barrier cells. This is a molecule that actively removes trospium chloride from the CNS.

10:58.

Take a look. This slide shows that the physico-chemical properties of trospium chloride result in it having an extremely high hydrophilicity and low lipophilicity. Accordingly, it does not penetrate the blood-brain barrier.

If a drug does not cross the blood-brain barrier, it has a significantly better side effect profile. Especially related to the action on the central nervous system. This is especially important in children, as well as in elderly patients who have a number of concomitant diseases that affect brain function. For example, encephalopathy, strokes. Such patients may be taking a wide range of other drugs that already affect the CNS.

Low penetration through the blood-brain barrier is a definite advantage of trospium chloride over other agents.

How else can the available antimuscarinics be compared?

You can see in this table that trospium chloride, unlike oxybutynin, tolterodine, solifenacin, is practically not metabolized in the liver. It does not have the anticholinergic metabolites that are commonly associated with most of the side effects. Due to this, it naturally does not affect the pharmacokinetics of other drugs that patients can take in parallel with antimuscarinic drugs.

Another interesting point. Trospium chloride, unlike other drugs, is excreted in the urine in an almost unchanged form by the kidneys. This allows him to have a certain local effect, which is very important.

It is believed that acetylcholine is released not only from nerve fibers, but also from the urothelium in response to its stretching. It activates muscarinic receptors located in urothelial cells. They secrete adenosine-3 phosphoric acid. It activates adrenergic receptors on sensory fibers and causes a sensation of urgency.

Being in the urine, trospium chloride is able to block the muscarinic receptors of the urothelium, thus disrupting one of the components, one of the links in the pathogenesis of an overactive bladder (compared to other drugs that do not penetrate into the urine, but act while being exclusively in the blood serum).

14:00

These drugs are known to be highly effective. On average, it is believed that in 77% of patients, antimuscarinic drugs reduce the symptoms present. I will not repeat, give comparative tables. I will show only the data of 2009th and 2010 years. These are data from a study of trospium chloride, which clearly shows how the use of the drug changes the structure of urgency.

If at the beginning of treatment medium and strong urgency prevails, then as a result of the use of the drug, patients note either a slight urgency, or it disappears altogether.

This slide shows the data of our department. We have used the drug in patients with various types of overactive bladder. This is an idiopathic active bladder and its association with benign prostatic hyperplasia.

Also, you know, there is an overactive bladder without detrusor overactivity. This is a very complex category of patients with an unclear mechanism for the onset of symptoms. Also in patients with neurogenic detrusor hyperactivity as a result of diseases of the spine and Parkinson’s disease.

The drug showed itself well in the form of a decrease in the number of urination per day, an increase in the volume of urination, which was confirmed by urodynamic data in the form of an increase in cystometric capacity.

However, I repeat that in all groups the results were significant, with the exception of an overactive bladder without detrusor overactivity. This, apparently, is due to the fact that the symptoms are not associated with muscarinic mechanisms, but with some other: purinergic or adrenergic.

What is very important?

The effect of trospium chloride, according to our data, can persist for quite a long time. This slide shows that for 2 years, those patients who remained under our supervision (17 patients out of 47) maintained a good effect in the form of a decrease in the number of urination and urgency. It not only was not inferior to the initial data obtained three months later, but even surpassed it in a number of cases.

16:45

Another interesting piece of information. Today, trospium chloride exists in pharmacies at a dose of 5 and 15 mg. In Europe, it still exists in a dose of 30 mg. Finally, starting this summer, it will be sold in our pharmacies. Patients will be able to purchase trospium at a dose of 30 mg per tablet.

If you take a look at these charts, they reflect a survey of over 3,000 doctors. These are general practitioners, urologists and gynecologists (unfortunately, gynecologists did not fit on this slide). You can see that most general practitioners prefer the initial dose of 30 mg per day, while urologists are already more bold in their choice and use (a quarter of urologists use) a dose of 45 mg per day.

What is a good drug? The drug is very easy to titrate. Its dose can be either reduced or increased depending on the desired effect and the severity of side effects. If general practitioners used the maximum dosage of mainly 60 mg per day, then urologists absolutely painlessly increase this dosage to 90 mg per day.

There are scientific studies that confirm the complete safety of the drug in such a high dosage.

As a rule, general practitioners prefer to prescribe the drug once or twice a day, while specialists prescribe it two or three times a day.

At the bottom of the slide, notice some very interesting data. If the drug trospium chloride is prescribed in a single dose of 45 mg, then the level of its concentration is almost the same as that of tolteradine prolonged form. This suggests that the drug does not need some new form that would allow it to be released slowly to reduce the number of side effects and save the drug from the presence of peak concentrations and fluctuations.

Despite the presence of a certain choice and an abundance of drugs, in my opinion, the most optimal in terms of treating patients with an overactive bladder, I consider the drug trospium chloride due to its certain properties.

No penetration through the blood-brain barrier, no central side effects, no metabolism in the liver and cross-interaction with other drugs, local action on the urothelium, the possibility of flexible selection of the optimal dosage from 15 to 90 mg per day.

The drug begins to act quickly enough – from 3 to 7 days. If after a week there is no effect, there is no need to wait and make the patient suffer with the existing symptoms. You can choose other means.

Finally, the pharmacokinetics of the drug allows you to use it not only three times a day, as recommended, but you can use it 1 and 2 times a day, which does not affect its fluctuations in serum concentration and allows you to achieve a good clinical effect.

Thank you.

20:45

Oksana Drapkina: Thank you very much. Have questions.

Maxim Shkolnikov: So, a question.

What are the first symptoms of an overactive bladder in women? With what diseases should a differential diagnosis be made?

A very good question. I would not divide questions into the first and second. There is only one main symptom – this is urgency (the appearance of a sudden strong urge that a person cannot tolerate).

Of course, this symptom can also occur with other obvious urological diseases: bladder stone, cystitis, prostate adenoma. When you rule out all of these obvious urological conditions and find no reason to explain these symptoms, this is the patient that can be diagnosed with an overactive bladder.

Second question.

How long do patients with an overactive bladder have to take antimuscarinic drugs?

The question is also relevant, since we are forced to say that the drugs work while you take them. Once patients stop taking antimuscarinics, unfortunately, symptoms tend to return.

International recommendations advise extending the course of treatment for about three months. In the future, the patient can stop taking and assess their symptoms. If the symptoms don’t come back, great. We helped, we healed. If the symptoms return, unfortunately, patients are again forced to take these drugs.

22:29

Oksana Drapkina: You have another very interesting question. Can I read it so people can hear?

Maxim Shkolnikov: Of course.

Oksana Drapkina: Are the terms “overactive bladder syndrome” and “irritable bowel syndrome” equivalent in essence?

Maxim Shkolnikov: Also a good question. I believe that these conditions are indeed equivalent: both here and there, patients are forced to go to the toilet frequently. In one case, to urinate. In another case, to empty the rectum. Already from this point of view they are equivalent.

But even if we consider the pathogenetic mechanisms, then, in my opinion, everything is also similar here, because an overactive bladder can also be called an irritated bladder, despite the fact that we do not have any visible obvious reasons that could lead to this condition. Same as with IBS.

Valentin Fadeev: In veterinary practice, due to a certain structure, let’s say, combined in a number of animals (in birds, in my opinion), this would be something pathogenetically unified.

Oksana Drapkina: Interesting idea!

Valentin Fadeev: Use in animals? In dogs, so that you can go for walks with them less often!

Oksana Drapkina: Maxim Evgenievich, everything you are telling us about today. See how useful it is for us to communicate! All of Russia is watching us now. I think the different topics that we are discussing today give rise to different questions. Before that, I had irritable bowel syndrome. Now overactive bladder syndrome. These questions are born. This is the power of internal disease!

Active ingredient OXYBUTYNINUM | Compendium – drug reference book

• Pharmacological properties
• Indications OXYBUTYNIN
• Application of OXYBUTYNIN
• Contraindications
• Side effects
• Special instructions
• Interactions
• Overdose
• Diagnosis
• Recommended alternatives
• Trade names

Medicines containing the active substance OXYBUTYNIN

Driptan ^®

tablets 5 mg, no. 30

Abbott Laboratories GmbH

Pharmacy prices 30

Kiev Vitamin Plant

Prices in pharmacies

antispasmodic effect on the smooth muscles of the bladder detrusor, and also has an M-anticholinergic effect. In patients with neurogenic bladder dysfunction, oxybutynin increases bladder volume, slows down spontaneous contractions of the detrusor muscle, and reduces the number of urges to urinate.

C _{max oxybutynin in blood plasma is observed 45 minutes after ingestion. Plasma concentration is proportional to the dose taken. T ½ – about 2 hours}

neurogenic bladder dysfunction; enuresis in children over 5 years of age.

adults are usually prescribed 5 mg 2-3 times a day, elderly patients – 5 mg 2 times a day.

For enuresis in children over 5 years of age, 5 mg 2-3 times a day with the last dose at night.

Increase the dose gradually.

intestinal obstruction, significant disturbances in urodynamics with the risk of urine precipitation, intestinal atony, ulcerative colitis and Crohn’s disease, megacolon, myasthenia gravis, glaucoma, age up to 5 years.

sensation of dry mouth, constipation, decreased visual acuity, nausea, dyspepsia, vasomotor reactions (hot flashes), difficulty urinating; headache, urinary retention, dizziness, drowsiness, dry skin, diarrhea, arrhythmia are less commonly noted.

should be used with caution in debilitated elderly patients, in individuals with neurocirculatory dystonia, with severe liver and kidney disease.

Against the background of the use of oxybutynin, it is sometimes possible to increase the severity of symptoms of hyperthyroidism, coronary artery disease, congestive heart failure, arrhythmia, tachycardia and prostatic hypertrophy.

As with any anticholinergic, caution should be exercised when administering oxybutynin to patients with hiatal hernia associated with reflux esophagitis.

The safety of oxybutynin during pregnancy has not been established. Should not be given during lactation.

The use of oxybutynin may be accompanied by drowsiness and decreased visual acuity, which must be taken into account when driving vehicles and working with potentially dangerous mechanisms.

due to the possibility of potentiation of anticholinergic effects, caution should be exercised when using oxybutynin and other anticholinergics together; in view of the isolated reports of interactions of anticholinergic drugs with phenothiazines, amantadine, butyrophenones, levodopa, digitalis preparations and tricyclic antidepressants, such combinations should be used with caution.

overdose symptoms range from an increase in the severity of the usual side effects to disorders of the central nervous system (anxiety, psychomotor agitation, rarely psychosis) and the cardiovascular system (vegetative reactions, decreased blood pressure), in exceptional cases – to respiratory failure, paralysis and coma .

Treatment: gastric lavage, slow intravenous administration of physostigmine 1-2 mg (repeated if necessary, up to 5 mg). With the development of hyperthermia – symptomatic treatment (cool wraps, local hypothermia). With severe arousal, 10 mg of diazepam is administered intravenously, with tachycardia – propranolol IV.