oxybutynin chloride (redirected from Ditropan xl)

ox·y·bu·ty·nin chloride (ks-bytn-n)

n.

An anticholinergic drug used to treat incontinence and other urinary symptoms.

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oxybutynin chloride

[ok′sibo̅o̅′tinin]

an anticholinergic.

indication It is prescribed in the treatment of neurogenic bladder.

contraindications Glaucoma, obstruction of the GI or urinary tract, ulcerative colitis, paralytic ileus, toxic megacolon, or known hypersensitivity to this drug or to other anticholinergics prohibits its use.

adverse effects Among the more serious adverse effects are decreased sweating, urinary retention, blurred vision, tachycardia, and severe allergic reactions.

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oxybutynin chloride (ok´sēbū´tinin klor´īd),

n brand name: Ditropan;
drug class: antispasmodic;
action: relaxes smooth muscles in urinary tract;
use: antispasmodic for neurogenic bladder.

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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.