Cystrin


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Related to Cystrin: Lyrinel, Lyrinel XL

oxybutynin

Cystrin (UK), Kentera (UK), Oxytrol

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

Topical gel: 1 g in 1.14-ml sachet

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; or apply contents of one gel sachet daily.

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 oral forms without regard to food.
• Don't crush or break tablets.
• Apply contents of one gel sachet to dry, intact skin on the abdomen, upper arms, shoulders, or thighs.

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, application-site reactions

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, jimsonweed, 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.
• Instruct patient to apply contents of one gel sachet daily to dry, intact skin on the abdomen, upper arms, shoulders, or thighs. Tell patient to use a new skin area daily. Advise patient to cover application site with clothing if skin-to-skin contact at application site is anticipated and to wash hands immediately after product application. Warn patient that gel is flammable and to avoid open fire or smoking until gel has dried.
• 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.

Cystrin

A brand name for OXYBUTYNIN.
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