Oxybutynin Chloride - (Ditropan)

oxybutynin chloride
(oks-ee-BYOO-tih-nin KLOR-ighd)

Why is this drug prescribed?

Ditropan relaxes the bladder muscle and reduces spasms. It is used to treat the urgency, frequency, leakage, incontinence, and painful or difficult urination caused by a neurogenic bladder (altered bladder function due to a nervous system abnormality).

Most important fact about this drug

Ditropan can cause heat prostration (fever and heat stroke due to decreased sweating) in high temperatures. If you live in a hot climate or will be exposed to high temperatures, take appropriate precautions.

How should you take this medication?

Take this medication exactly as prescribed.

Ditropan can make your mouth dry. Sucking hard candies or melting bits of ice in your mouth can remedy the problem.

If you miss a dose...

Take the forgotten dose as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at once.

Storage...

Keep this medication in a tightly closed container and store it at room temperature. Protect the syrup from direct light.

Pharmacologic class: synthetic tertiary amine
Therapeutic class: antispasmodic
Pregnancy risk category: B

How supplied

Tablets: 5 mg.
Syrup: 5 mg./5 ml.

Pharmacokinetics

Absorption: absorbed rapidly.
Distribution: unknown.
Metabolism: metabolized by liver.
Excretion: excreated primarily in urine.

Pharmacodynamics

Chemical effect: produces direct spasmolytic effect and antimuscarinic (atropine-like) effect on uninary tract smooth muscles, increasing bladder capacity and providing some local anesthesia and mild analgesia.
Therapeutic effect: relieves bladder spasms.

Indications and dosage

Antispasmodic for uninhibited or reflex neurogenic bladder.

Adults:

• Tablets - The usual dose is one 5 milligram tablet taken 2 to 3 times a day. You should not take more than 4 tablets a day.
• Syrup - The usual dose is one teaspoonful 2 to 3 times a day, but not more than 4 times a day.

Children over 5 years of age:

• Tablets - The usual dose is one 5 milligram tablet taken twice a day. The most a child should take is 3 tablets a day.
• Syrup - The usual dose is one teaspoonful 2 times a day, but not more than 3 times a day. Ditropan is not recommended for children under 5 years of age.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Ditropan.

Side effects may include:

• allergic reactions
• bloated feeling
• constipation
• cycloplegia
• decreased production of tears
• decreased sweating
• difficulty falling or staying asleep
• dilation of the pupil of the eye
• dim vision
• dizziness
• drowsiness
• dry mouth
• eye paralysis
• fever
• flushing
• hallucinations
• impaired alertness
• impotence
• inability to urinate
• mydriasis
• nausea
• palpitations
• rapid heartbeat
• rash
• restlessness
• suppression of milk production
• tachycardia
• transient blurred vision
• urinary hesistancy
• urine retention
• urticaria
• vomiting
• weakness

Other Interactions

Drug-drug.

Anticholinergics: increased anticholinergic effects. Use cautiously. Arenolol, digoxin: increased levels of these drugs. Monitor closely.
CNS depressants: increased CNS effects. Use cautiously.
Haloperidol, levodopa: decreased levels of these drugs. Monitor closely.

Drug-lifestyle:

Alcohol use: increased CNS effects. Use cautiously.
Exercise, hot weather: may precipitate heat stroke. Use cautiously.

Contraindications and precautions

• Contraindicated in patients with myasthenia gravis, GI obstruction, glaucoma, adynamic ileus, megacolon, severe colitis, ulcerative colitis when megacolon is present, obstructive uropathy, or hypersensitivity to drug, in elderly or debilitated patients with intestinal atony; and in hemorrhaging patients with unstable CV status.
• The effects of Ditropan during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Ditropan may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to stop breastfeeding until your treatment is finished.
• Use cautiously with elderly patients, and in those with autonomic neuropathy, reflux esophagitis, or hepatic or renal disease.

Special information

If you are pregnant or breastfeeding

The effects of Ditropan during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Ditropan may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to stop breastfeeding until your treatment is finished.

When should this drug not be prescribed?

You should not take Ditropan if you have certain types of untreated glaucoma (excessive pressure in the eye), partial or complete blockage of the gastrointestinal tract, or paralytic ileus (obstructed bowel). Ditropan should also be avoided if you have severe colitis (inflamed colon), myasthenia gravis (abnormal muscle weakness), or urinary tract obstruction. This drug is usually not prescribed for the elderly or debilitated.

Do not take this medication if you are sensitive or have ever had an allergic reaction to it. Make sure your doctor is aware of any allergic reactions you have experienced.

Special warnings about this medication

If you have an ileostomy or colostomy (an artificial opening to the bowel) and develop diarrhea while taking Ditropan, inform your doctor immediately.

Ditropan may cause drowsiness or blurred vision. Driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended until you know how this medication affects you.

Your doctor will prescribe Ditropan with caution if you have liver disease, kidney disease, or a nervous system disorder.

Ditropan may aggravate the symptoms of overactive thyroid, heart disease or congestive heart failure, irregular or rapid heartbeat, high blood pressure, or enlarged prostate.

Possible food and drug interactions when taking this medication

If Ditropan is taken with certain other drugs, the effects of either may be increased, decreased or altered. It is especially important to check with your doctor before combining Ditropan with alcohol or sedatives such as Halcion or Restoril because increased drowsiness may occur.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of Ditropan overdose may include:

• coma
• convulsions
• delirium
• difficulty breathing
• fever
• flushing
• hallucinations
• irritability
• low or high blood pressure
• nausea
• paralysis
• rapid heartbeat
• restlessness
• tremor
• vomiting

NURSING CONSIDERATIONS

Assessment

• Assess patients bladder condition before therapy.
• Before giving drug, anticipate confirmation of neurogenic bladder by cystometry and rule out partial intestinal obstruction in patients with diarrhea, especially those with colostomy or ileostomy.
• Prepare patient for periodic cystometry to evaluate response to therapy.
• Be alert for adverse reactions.
• Drug may aggravate symptoms of hyperthyroidism, coronary artery disease, heart failure, arrhythmias, tachycardia, hypertension, or prostatic hyperplasia.
• Evaluate patient's and family's knowledge of drug therapy.

Nursing diagnoses

• Pain related to bladder spasms.
• Risk for injury related to drug-induced adverse CNS reactions.
• Knowledge deficit related to drug therapy.

Planning and implementation

• If urinary tract infection is present, administer antibiotics, as ordered.
• To minimize tendency toward tolerance, be prepared to stop therapy periodically iodetenmne whether patient can get along without it.
• 
  Patient teaching
• Warn patient to avoid hazardous activilies until CNS effects are known.
• Caution patient that using drug in hot weather may precipitate fever or heatstroke.
• Advise patient to store drug in tightly closed containers at 59 ° to 86 ° F (15° to 30° C).

Evaluation

• Patient is free from bladder pain.
• Patient sustains no injuries due to drug-induced adverse CNS reactions.
• Patient and family state understanding of drug therapy.

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