Oxybutynin

What is oxybutynin?

Oxybutynin belongs to a class of drugs called anticholinergic (antimuscarinic) agents. These drugs are the standard medications prescribed to treat overactive bladder that causes a frequent and uncontrollable urge to urinate, sometimes causing urinary incontinence.¹

Oxybutynin relaxes the bladder muscles by blocking the neurotransmitter acetylcholine. This reduces the tendency of the bladder to contract, lowering the pressure inside and allowing a little more time before you feel the urge to urinate.²

The drug is only available with a doctor’s prescription.

What is oxybutynin used to treat?

Oxybutynin has been approved by the US Food and Drug Administration (FDA) for the treatment of overactive bladder in adults and children. Symptoms include an urgent or frequent need to urinate, sometimes causing an involuntary loss of urine and needing to urinate often at night.³

The oral immediate-release form can be taken by children aged five years and older, but the patch and gel formulations are approved for use by adults only.

The FDA has also approved extended-release oxybutynin tablets for treating children aged six years and older with symptoms of detrusor overactivity linked to a neurological condition such as spina bifida.⁴

Sometimes, doctors prescribe oxybutynin off-label for children under the age of five with overactive bladder or for conditions like bladder spasms caused by indwelling catheters and stents.⁵

It has also been studied for use in treating primary hyperhidrosis, a condition characterized by excessive sweating. However, these are not FDA-approved indications for oxybutynin.⁶

Dosage forms and strengths

Oxybutynin is available in the following dosage formulations and strengths for oral, topical, and transdermal administration:

• Immediate-release tablet (generic): 5mg⁷

• Extended-release (long-acting) tablet

  • Generic: 5mg, 10mg, 15mg⁸

  • Ditropan XL: 5mg, 10mg⁹

• Syrup/solution (generic): 5mg/5mL¹⁰

• Topical 10% gel (Gelnique): 100mg/pump, 100mg/packet¹¹

• Transdermal patch (Oxytrol): 3.9mg/day¹²

How do you take oxybutynin?

Take oxybutynin according to your doctor’s instructions. Don’t start or stop taking the drug without consulting your doctor. Seek clarification from a doctor or pharmacist if you don’t understand how to take your medication.

Tell your doctor if you or your child find it difficult to swallow tablets. They may prescribe a different formulation. Taking the tablet with plenty of water or other liquids may help.

If you are prescribed the liquid formulation, prepare your dose using a dose-measuring spoon or cup. Don’t use a household spoon, as it may not accurately measure your prescribed dose.

The patch should be applied to the skin over the hip, thigh, or upper arm and left in place for the prescribed number of days. 

The gel is applied on the skin of the abdomen, upper arm, or thigh according to the prescribing instructions. The site should be covered with clothing to avoid transference to others through skin-to-skin contact. Wash your hands immediately after applying the gel, and refrain from immersing yourself in water for at least one hour. The gel is flammable and should be allowed to dry before sitting near an open fire or smoking.

The sites for both the gel and patch formulations should be rotated with each application.

Seeing results

You may need to wait 6–8 weeks after beginning treatment to see the maximum improvement in your symptoms. However, most people will notice some improvements within two weeks.¹³

With immediate-release oxybutynin tablets, peak plasma concentration levels are reached within one hour of administration.¹⁴

After you take your first dose of oxybutynin extended-release tablets, plasma concentration levels rise for 4–6 hours. Your body will maintain steady concentrations for up to 24 hours.¹⁵

It takes seven days to reach steady concentrations with continuous dosing of Gelnique. Where you apply the gel on your body doesn’t significantly affect absorption.¹⁶

If your symptoms are not alleviated after taking the medication for two weeks, speak to your doctor. Your dosage may need an adjustment, or an alternative treatment may be prescribed if needed.

Who should not take oxybutynin?

You should not take this drug if you have any of the following:¹⁷

• Urinary retention

• Gastric retention or other gut motility disorders

• Hypersensitivity to oxybutynin or any of its inactive ingredients (you can see a full list of ingredients on the medication label, or ask for one from your doctor or pharmacist)

• Uncontrolled angle-closure glaucoma

Oxybutynin should be used with caution in people with the following conditions:¹⁸

• Controlled narrow-angle glaucoma

• Hyperthyroidism

• Ulcerative colitis

• Partial obstructive uropathy

• Benign prostatic hyperplasia

• Dementia being treated with cholinesterase inhibitors such as donepezil (Aricept) and rivastigmine (Exelon)

• Parkinson’s disease

• Myasthenia gravis

• Kidney or liver disease

• Chronic alcohol use

• Hiatal hernia

• Gastroesophageal reflux disease (GERD)

• Heart failure

• Cardiac arrhythmia

• Hypertension

Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant. They may advise you not to take oxybutynin.

Potential side effects of oxybutynin

Inform your doctor if any of the following common side effects persist:¹⁹

• Dry mouth

• Dizziness

• Constipation

• Drowsiness

• Nausea

• Diarrhea

• Blurred vision

• Dry eyes

• Urinary hesitancy

• Headache

• Nervousness

• Indigestion

• Urinary retention

• Insomnia

• Skin reaction at the application site (gel, patch)

Some side effects can be severe. If you develop any of the following, talk to your doctor immediately or seek emergency medical care:

• Fast, pounding, or irregular heartbeat; palpitations

• Painful, frequent, or urgent urination

• Difficulty swallowing or breathing

• Hoarse voice

• Rash

• Hives

• Swelling of the eyes, face, lips, throat, or tongue

• Confusion, memory problems, delirium, hallucinations

• Fever, heatstroke²⁰

This is not an exhaustive list of adverse effects. Consult with your doctor immediately if you experience unusual symptoms when taking this drug.

Overdose

If you think you or someone else has taken too much oxybutynin, call 911 or go to your nearest emergency department. You can also contact the National Poison Control Center helpline at 1-800-222-1222.

Possible signs of an oxybutynin overdose include any of the following:²¹

• Feeling restless, irritable

• Shaking

• Fever

• Flushing

• Dry skin

• Wide pupils

• Trouble urinating

• Confusion, loss of consciousness

• Hallucination

• Irregular heartbeat or palpitations

• Low blood pressure

• Vomiting

• Difficult or slow breathing

• Seizure

• Paralysis

• Coma

Allergy information

Oxybutynin can cause allergic reactions in people who are hypersensitive to the drug or any of its ingredients. Signs of an allergic reaction to this drug include the following:²²

• Skin rash, hives, peeling skin

• Swelling of the mouth, throat, or tongue with an obstructed airway

• Vomiting

• Rapid heart rate

• Wheezing, difficulty breathing

• Loss of consciousness

Seek medical attention if you experience any of these symptoms. Call 911 if your symptoms are severe.

Long-term use of oxybutynin

Taking immediate- or extended-release oxybutynin over a long period of time was found to be safe and effective.²³

If your doctor prescribes oxybutynin for long-term use, follow their usage instructions carefully. Attend check-ups regularly to monitor your health and assess the continued need for the medication.

Pregnancy category

Oxybutynin is listed as a pregnancy category B medication by the FDA. This means data obtained from animal studies did not find evidence of harm to the fetus. However, there are no adequate studies in humans to determine if the drug is safe for use in pregnant women.²⁴

Oxybutynin and pregnancy

Tell your doctor if you are pregnant or planning a pregnancy before taking this drug. Make sure to inform them immediately if you find out you are pregnant during treatment with oxybutynin.

More research is needed to fully understand oxybutynin’s effects during pregnancy. Your doctor will only prescribe this drug if its expected benefits outweigh the potential risks.

Oxybutynin and breastfeeding

It is not known how the drug affects breastfeeding women and infants. There is evidence of reduced breast milk production with the use of other anticholinergic drugs. Your baby’s doctor will monitor for signs that your baby is not receiving enough milk.²⁵ ²⁶

Missed doses

Take your missed dose as soon as you remember. If it’s almost time to take the next dose, skip the one you missed and resume your regular dosing schedule. To avoid overdosing, don’t take two doses to make up for the missed one.

Since oxybutynin doses should be taken at regular intervals, setting a reminder can help you follow a consistent schedule and avoid missing doses.

Drug interactions

Oxybutynin may interact with other drugs, such as:²⁷

• Potassium supplements, such as potassium acid phosphate, potassium chloride, and others

• Sleeping pills, such as doxylamine (Unisom)

• Other anticholinergic drugs, such as glycopyrrolate and scopolamine transdermal

• Antifungal medications like ketoconazole

• Gastrointestinal drugs:

• Prokinetic agents, such as metoclopramide (Metozolv ODT, Reglan)

• Antinausea medicines like dronabinol (Syndros), promethazine, and trimethobenzamide

• Others, such as eluxadoline (Viberzi)

• Antidepressants like phenelzine (Nardil), tranylcypromine (Parnate), and amitriptyline

• Antihistamines like cetirizine (Quzyttir, Zyrtec)

• Antiseizure medications such as brivaracetam (Briviact), carbamazepine (Epitol), ethosuximide (Zarontin), and others

• Diabetes medicines, such as pramlintide (Symlin)

• Muscle relaxants like chlorzoxazone (Lorzone)

• Pain medications, such as morphine, methadone, gabapentin, and tramadol

• Sedatives like alprazolam (Xanax) and diazepam (Valium)

• Alcohol, marijuana, kratom, kava

Can I drink alcohol while taking oxybutynin?

Consuming alcohol is contraindicated while taking oxybutynin due to the risk of excessive drowsiness.²⁸

What to discuss with your doctor before starting oxybutynin

Discuss any concerns and risk factors with your doctor before starting this medication. These might include:

• Allergies: Inform your doctor if you are allergic to oxybutynin, its ingredients, or any similar medicines. Mention any past allergic reactions and whether you are allergic to any other medication.

• Medications: Oxybutynin may affect how certain drugs work and their effects on your body. Inform your doctor of all other prescription and over-the-counter drugs, vitamins, supplements, and herbal products you are currently taking, take occasionally, or plan to start taking.

• Medical conditions: Tell your doctor if you have any other medical conditions, including bladder problems, narrow-angle glaucoma, dementia, myasthenia gravis, or Parkinson’s disease. Also mention any history of gastric or intestinal blockage, gastroesophageal reflux disease, or slow digestion.

• Pregnancy and breastfeeding: Tell your doctor if you are pregnant, planning a pregnancy, or breastfeeding.

• Planned surgery: Tell your doctor if you have any surgery planned, including dental procedures. And let the surgeon or dentist know that you are taking oxybutynin.

Stopping oxybutynin

Do not stop taking oxybutynin without your doctor’s guidance or until you finish your prescription.

Stopping anticholinergic medications like oxybutynin abruptly can cause adverse effects, particularly in older adults. These effects lead to rebound symptoms of anticholinergic withdrawal and can include tachycardia, urinary incontinence, sweating, anxiety, and nausea.²⁹

To reduce the risk of developing these symptoms, your doctor may taper your medication gradually.

Drug approval history

Here are some key dates in the drug’s history:

• 1975: The FDA approved immediate-release oral oxybutynin to be sold under the brand name Ditropan. This branded formulation has since been discontinued, but the generic version of the drug is still available.³⁰

• 1979: Ditropan was approved as a syrup for oral administration. The branded version has been discontinued, but the formulation is still available as a generic medication.³¹

• 1998: An extended-release formulation was approved by the FDA — Ditropan XL. It was originally approved in 5mg and 10mg strengths. A 15mg extended-release tablet later became available but has since been discontinued (although it is still available as a generic product).³²

• 2003: Oxytrol, a transdermal patch, was approved by the FDA.³³

• 2009: The FDA approved Gelnique, a topical gel formulation of oxybutynin.³⁴

Tips for taking oxybutynin

The following tips can help you take this medication safely and effectively:

• Follow your doctor or pharmacist’s instructions carefully when taking this drug. Don’t take more or less than prescribed, and avoid starting or discontinuing it without medical guidance.

• Take the medicine with a full glass of water, and try to take it around the same time every day.

• If you are using the patch or topical gel formulation, apply it to a different body site with each use. Wash your hands immediately after applying the gel.

• Oxybutynin gel is flammable. Allow it to dry before sitting near an open fire or smoking.

• Keep taking your medication according to your doctor’s instructions — even if you feel better.

• Don’t operate machinery or drive until you know how this drug affects you. It can cause drowsiness and blurred vision.³⁵

• Avoid extreme heat while taking oxybutynin. The drug can make it difficult for your body to cool down effectively, possibly causing heat stroke and other adverse effects.³⁶

• Store the medication at 20–25°C (68–77°F).³⁷

• If you or your child find it difficult to take tablets, you can ask your doctor to prescribe a different form, such as a topical or liquid formulation.

• Keep the medication out of the reach of children.