Di·tro·pan (d  tr -pn) A trademark for the drug oxybutynin chloride. |
Ditropan,
oxybutynin chloride
Ditropan, Ditropan XL, Lyrinel XL (UK)
Pharmacologic class: Anticholinergic
Therapeutic class: Urinary tract antispasmodic
Pregnancy risk category B
Action
Inhibits acetylcholine action at postganglionic receptors, relaxing smooth muscle lining of GU tract and preventing bladder irritability
Availability
Syrup: 5 mg/5 ml
Tablets: 5 mg
Tablets (extended-release): 5 mg, 10 mg, 15 mg
Transdermal system (patch): 39 cm2/36 mg
⊘Indications and dosages
➣ Frequent urination, urinary urgency or incontinence, and nocturia caused by neurogenic bladder; overactive bladder
Adults: 5 mg P.O. two to three times daily (not to exceed 5 mg q.i.d.); or 5 to 15 mg P.O. once daily (extended-release); or one 3.9 mg/day transdermal system applied twice weekly
Children older than age 5: 5 mg P.O. b.i.d., to a maximum of 5 mg t.i.d.
Dosage adjustment
• Elderly patients
Contraindications
• Hypersensitivity to drug
• Glaucoma
• Intestinal obstruction, severe colitis, atony, paralytic ileus, megacolon, or hemorrhage
• Obstructive uropathy, urinary retention
• Myasthenia gravis
• Acute hemorrhage with shock
Precautions
Use cautiously in:
• cardiovascular disease, hyperthyroidism, GI disease
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 5 (safety not established).
Administration
• Give without regard to food.
• Don't crush or break tablets.
| Route | Onset | Peak | Duration |
| P.O. | 30-60 min | 3-6 hr | 6-10 hr |
| P.O. (extended) | 30-60 min | 3-6 hr | Up to 24 hr |
| Transdermal | 24-48 hr | 48-96 hr | 96 hr after removal |
Adverse reactions
CNS: dizziness, drowsiness, hallucinations, insomnia, weakness, anxiety, restlessness, headache
CV: palpitations, hypotension, tachycardia
EENT: blurred vision, cycloplegia, increased intraocular pressure, mydriasis, photophobia
GI: nausea, vomiting, diarrhea, constipation, bloating, dry mouth
GU: urinary hesitancy, urinary retention, erectile dysfunction, suppressed lactation
Metabolic: hyperthermia
Skin: decreased sweating, urticaria
Other: allergic reactions, fever, hot flashes
Interactions
Drug-drug. Anticholinergics, anticholinergic-like drugs (including amantadine, antidepressants, disopyramide, haloperidol, phenothiazines): additive anticholinergic effects
Atenolol: increased atenolol absorption
CNS depressants (including antidepressants, antihistamines, opioids, sedative-hypnotics): additive CNS depression
Digoxin: increased digoxin blood level (with extended-release oxybutynin)
Haloperidol: decreased haloperidol blood level, tardive dyskinesia, worsening of schizophrenia
Levodopa: decreased levodopa efficacy
Nitrofurantoin: increased nitrofurantoin blood level, greater risk of toxicity
Drug-herbs. Angel's trumpet, jimson-weed, scopolia: increased anticholinergic effects
Drug-behaviors. Alcohol use: additive CNS depression
Patient monitoring
• Monitor vital signs and temperature. Watch for hypotension, fever, and tachycardia.
• Evaluate patient's vision.
• Assess results of cystometric studies. Stay alert for urinary retention.
Patient teaching
• Tell patient he may take with or without food. Caution him not to crush, break, or chew extended-release tablets.
• Instruct patient to apply transdermal patch to dry, intact skin on abdomen, hip, or buttock. Tell him to use a new skin area with each new system and not to reapply new patch to same site within 7 days. Caution him not to cut or puncture patch.
• Tell patient to report blurred vision, fever, skin rash, nausea, or vomiting.
• Advise patient he'll need to undergo periodic bladder exams.
• Caution patient to avoid driving and other hazardous activities if drug causes drowsiness or blurred vision.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.
Ditropan®
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