Oxybutynin

Overview

Oxybutynin, sold under the brand name Ditropan among others, is an anticholinergic medication primarily used to treat overactive bladder. It is widely considered a first-line therapy for overactive bladder due to its well-studied side effect profile, broad applicability, and continued efficacy over long periods of time. It works similar to tolterodine, darifenacin, and solifenacin, although it is usually preferred over these medications. It is commonly prescribed after some types of bladder surgery to reduce bladder spasms and catheter-associated discomfort. It is sometimes used off-label for treatment of hyperhidrosis, or excessive sweating. It has also been used off-label to treat bedwetting in children, but this use has declined, as it is most likely ineffective in this role. It is taken by mouth or applied to the skin. WP

Common side effects include dry mouth, constipation, dizziness, trouble sleeping, and urinary tract infections. Serious side effects may include urinary retention and an increased risk of heat stroke. Use in pregnancy appears safe but has not been well studied while use in breastfeeding is of unclear safety. It is an antimuscarinic and works by blocking the effects of acetylcholine on smooth muscle.[1][2] WP

Oxybutynin was approved for medical use in the US in 1975. It is available as a generic medication. In 2023, it was the 114th most commonly prescribed medication in the United States, with more than 5 million prescriptions.[1][3][4][5] WP

Drug class

Antimuscarinic WP

From the Wikipedia article's infobox.

Uses, dosage and effects

Medical use

Oxybutynin is used in the form of instant-release capsules, extended-release capsules, or transdermal products. All of these are considered safe and effective options for treatment of detrusor muscle-mediated overactive bladder. Extended-release formulations decrease the number of weekly incontinence episodes by an average of 90% compared to an untreated state. Some studies have identified advantages of transdermal oxybutynin over capsules, finding decreased frequency of incontinence episodes and increased average voided volume of urine.[1][6][7] WP

Oxybutynin has been established through head-to-head trials as a more effective for overactive bladder than tolterodine, another anticholinergic medication. Specifically, the extended-release form of oxybutynin was found to have greater effect in both the short- and long-term. However, oxybutynin is not selective for the bladder like tolterodine, and thus has a wider range of side effects. Tolterodine and other anticholinergics are primarily used when clinicians and patients want to reduce the side effect profile.[6][8] WP

Because both drugs have been studied extensively and shown relatively high efficacy, both oxybutynin and tolterodine are considered first-line treatments for overactive bladder. They are thus the typical choices for initial treatment of the condition. The choice of initial therapy often comes down to whether a patient prefers somewhat higher efficacy (oxybutynin) or somewhat reduced side effects (tolterodine).[9] WP

Hyperhidrosis

Since the 2010s, oxybutynin has increasingly been used to treat hyperhidrosis (excessive sweating). Numerous studies have identified concrete benefits of the drug in treating this condition, but have not identified appropriate dosing or the full spectrum of possible side effects, although dry mouth is seemingly infrequent in patients with hyperhidrosis. Until further clinical trials can be conducted, oxybutynin is only used as an off-label medication for hyperhidrosis (as of 2024).[10][11] WP

Risks and side effects

Adverse effects

Common adverse effects that are associated with oxybutynin and other anticholinergics include: dry mouth, difficulty in urination, constipation, blurred vision, drowsiness, and dizziness. Anticholinergics have also been known to induce delirium.[12][13] WP

Oxybutynin's tendency to reduce sweating can be dangerous. Reduced sweating increases the risk of heat exhaustion and heat stroke in apparently safe situations where normal sweating keeps others safe and comfortable. Adverse effects of elevated body temperature are more likely for the elderly and for those with health issues, especially multiple sclerosis.[14][15] WP

N-Desethyloxybutynin is an active metabolite of oxybutynin that is thought responsible for much of the adverse effects associated with the use of oxybutynin. N-Desethyloxybutynin plasma levels may reach as much as six times that of the parent drug after administration of the immediate-release oral formulation. Alternative dosage forms have been developed in an effort to reduce blood levels of N-desethyloxybutynin and achieve a steadier concentration of oxybutynin than is possible with the instant-release form. The long-acting formulations also allow once-daily administration instead of the twice-daily dosage required with the immediate-release form. The transdermal patch, in addition to the benefits of the extended-release oral formulations, bypasses the first-pass hepatic effect that the oral formulations are subject to.[16][17][18] WP

Contraindications

Oxybutynin chloride is contraindicated in patients with untreated narrow angle glaucoma, and in patients with untreated narrow anterior chamber angles—since anticholinergic drugs may aggravate these conditions. It is also contraindicated in partial or complete obstruction of the gastrointestinal tract, hiatal hernia, gastroesophageal reflux disease, paralytic ileus, intestinal atony of the elderly or debilitated patient, megacolon, toxic megacolon complicating ulcerative colitis, severe colitis, and myasthenia gravis. It is contraindicated in patients with obstructive uropathy and in patients with unstable cardiovascular status in acute hemorrhage. Oxybutynin chloride is contraindicated in patients who have demonstrated hypersensitivity to the product.[19][20] WP

Pharmacology

Pharmacology

Following oral administration, the drug is absorbed within one hour and has an elimination half-life of 2 to 5 hours. There is a wide variation among individuals in the drug's concentration in blood. This, and its low concentration in urine, suggest that it is eliminated through the liver.[21][22] WP

Research

Research

A large study linked the development of dementia in those over 65 to the use of oxybutynin, due to its anticholinergic properties.[23] WP

AD109 is an experimental drug which is a combination of aroxybutynin and atomoxetine. Several peer‑reviewed studies have evaluated AD109 for the treatment of obstructive sleep apnea (OSA). Aroxybutynin is a drug that can alter tongue muscle tone during sleep. Atomoxetine is a medication that enhances chemical transmission of norepinephrine in the brain, an action that boosts muscle tone in the airway while sleeping. In combination, these drugs appear to promote airway opening and tongue function during sleep, which may lead to improvement in the signs and symptoms of sleep apnea for some people. A large phase III randomized controlled trial (SynAIRgy) demonstrated that AD109 significantly reduced apnea–hypopnea index (AHI) and improved oxygenation over 26 weeks in adults unable to tolerate positive airway pressure therapy or a CPAP device. Earlier phase II trials, including the MARIPOSA study, also reported clinically meaningful reductions in AHI and improvements in patient‑reported outcomes with AD109 compared with placebo. Additional randomized studies have shown that noradrenergic–antimuscarinic combinations can reduce upper‑airway collapsibility and improve sleep‑related muscle tone, supporting the mechanistic rationale for AD109.[24][25][26] WP

Legal status

Brand names

Oxybutynin is available by mouth in generic formulation and under the brand names Ditropan, Lyrinel XL, Ditrospam, Kentera, and Aquiette, as a transdermal patch under the brand name Oxytrol, and as a topical gel under the brand name Gelnique.[27][28][29] WP

Chemistry

Formula

C22H31NO3 PC

CAS number

5633-20-5 PC

Molar mass (g/mol)

357.5 PC

IUPAC name (computed by PubChem)

4-(diethylamino)but-2-ynyl 2-cyclohexyl-2-hydroxy-2-phenylacetate PC

SMILES

CCN(CC)CC#CCOC(=O)C(C1CCCCC1)(C2=CC=CC=C2)O PC

InChIKey

XIQVNETUBQGFHX-UHFFFAOYSA-N PC

PubChem CID

4634

IUPAC name

4-Diethylaminobut-2-ynyl 2-cyclohexyl-2-hydroxy-2-phenylethanoate WP

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

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2. Other Oxybutynin Pregnancy and Breastfeeding Warnings
3. Other British National Formulary: BNF 76. 2018
4. Other Top 300 of 2023
5. Other Oxybutynin Drug Usage Statistics, United States, 2014 - 2023
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8. Journal / agency Loloi J, Clearwater W, Schulz A, Suadicani SO, Abraham N. Medical Treatment of Overactive Bladder. The Urologic Clinics of North America. May 2022. doi:10.1016/j.ucl.2021.12.005 · PMID 35428431
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12. Other British National Formulary. 2006
13. Other Andreasen NC, Black DW. Introductory Textbook of Psychiatry. 2006
14. Journal / agency Oxybutynin (By mouth)
15. Journal / agency White AT, Vanhaitsma TA, Vener J, Davis SL. Effect of passive whole body heating on central conduction and cortical excitability in multiple sclerosis patients and healthy controls. Journal of Applied Physiology. June 2013. doi:10.1152/japplphysiol.01119.2012 · PMID 23599395 · PMC3680823
16. Journal / agency Reitz AB, Gupta SK, Huang Y, Parker MH, Ryan RR. The preparation and human muscarinic receptor profiling of oxybutynin and N-desethyloxybutynin enantiomers. Medicinal Chemistry. November 2007. doi:10.2174/157340607782360353 · PMID 18045203
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21. Other Oxybutynin
22. Journal / agency Douchamps J, Derenne F, Stockis A, Gangji D, Juvent M, Herchuelz A. The pharmacokinetics of oxybutynin in man. European Journal of Clinical Pharmacology. 1988. doi:10.1007/bf00558247 · PMID 3234461
23. Journal / agency Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Internal Medicine. March 2015. doi:10.1001/jamainternmed.2014.7663 · PMID 25621434 · PMC4358759
24. Journal / agency Strollo, Patrick J. Aroxybutynin and atomoxetine (AD109) for obstructive sleep apnea: a randomized phase 3 trial (SynAIRgy). American Journal of Respiratory and Critical Care Medicine. 2026. doi:10.1093/ajrccm/aamag215
25. Journal / agency Schweitzer, Paula K. Combination of Aroxybutynin and Atomoxetine in the Treatment of Obstructive Sleep Apnea (MARIPOSA): A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine. 2023. doi:10.1164/rccm.202306-1036OC
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