STEPS

New Drug Reviews

Transdermal Oxybutynin (Oxytrol) for Urinary Incontinence

Am Fam Physician. 2004 Dec 15;lxx(12):2351-2352.

Synopsis

Oxytrol is a new transdermal patch form of the drug oxybutynin, which has long been used for urinary incontinence. Oxybutynin, via an anticholinergic effect, relaxes the detrusor muscle of the bladder. The transdermal form of the drug was developed to accost the side consequence of dry oral fissure. The patch avoids beginning-laissez passer metabolism in the liver, reducing the active metabolite N-desethyloxybutynin, the main cause of dry mouth.

Name Starting dosage Dose form Guess monthly cost*

Transdermal oxybutynin (Oxytrol)

1 patch topically, alternate sites every 3 to four days

Transdermal patch, 3.ix mg per day

$107†

Safety

Oxtybutynin should non exist used in patients with urinary retention, gastric retention, or uncontrolled angle-closure glaucoma.1 Because oxybutynin is metabolized in the liver and excreted via the kidney, patients with renal or hepatic impairment may feel a more pronounced response to the drug. The FDA pregnancy rating for this drug is category B.

Tolerability

Dry mouth is the most common complaint with the oral anticholinergic drugs oxybutynin and tolterodine. The incidence of dry out mouth is reported as roughly 10 percentage in the package labeling.1 In one study, the transdermal class of oxybutynin acquired dry mouth in fewer patients than the immediate-release oral form (30 versus 94 percent, P <.001, number needed to care for=ane.8).2 The transdermal formulation of oxybutynin has not been compared with the extended-release oral formulation. Another study compared transdermal oxybutynin with extended-release oral tolterodine, and found a like rate of dry mouth (iv.1 versus vii.3 percent).3 The difference in the rate of dry out mouth between studies (4.1 percent versus 10 percent versus 38 percent) may be due to differences in definition, population, and measurement. Other anticholinergic side furnishings such as constipation and somnolence are reduced slightly with the patch equally compared with oral therapy.1,3 Peel irritation and itching occurs in 10 to 20 percentage of patients, and about one in 10 patients will stop using the patch due to these symptoms. Patch adhesion is proficient, with less than ane percent partially or totally detaching.1,3

Effectiveness

Few studies accept evaluated the effectiveness of transdermal oxybutynin. It has been compared with immediate-release oral oxybutynin and extended-release tolterodine, but simply in previously treated patients. In 74 patients, mostly women, who previously responded to oral oxybutynin, the transdermal class produced a similar decrease in the number of episodes of incontinence to oral oxybutynin (vii.3 to vii.iv episodes per day while on placebo and ii.iv to 2.6 episodes per day while on handling).two When compared with long-interim tolterodine (Detrol LA) in both urge and mixed incontinence, transdermal oxybutynin and tolterodine produced a similar modest decrease in the number of incontinence episodes from seven to 9 episodes per mean solar day to 5 to 7 episodes per day (P <0.05 compared with placebo).three Neither study reported the number of patients who were completely continent or a decline in the frequency of night micturition. Older studies with the oral course showed more impressive results, but it is not clear whether that was due to dissimilar populations used or different dosing.4,5

Toll

Transdermal oxybutynin will cost patients approximately $100 per month, similar to the price of the extended-release forms of oxybutynin and tolterodine, and much more than the generic version of firsthand-release oxybutynin ($xv to 30 per month).

Simplicity

The transdermal patch is applied to the belly, buttock, or hip, rotating sites every three to 4 days.

Bottom Line

The transdermal patch of oxybutynin is no more than constructive than the brusk- or long-acting oral grade. The patch costs more, but causes less dry mouth. Skin reactions will cause well-nigh 10 percent of patients to stop using it.

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The Writer

PAMELA DULL, Thou.D., is assistant clinical professor, Department of Family unit Medicine, College of Medicine, Ohio State Academy, Columbus.

REFERENCES

bear witness all references

ane. Oxytrolproductmonograph.WatsonPharma, Inc. Accessed online November 22, 2004, at: http://pi.watsonpharm.com/prescribing_info.asp?blazon=pi&amp;p=17. ...

two. Davila GW, Daugherty CA, Sanders SW, Transdermal Oxybutynin Study Group. A short-term, multicenter, randomized double-blind dose titration study of the efficacy and anticholinergic side effects of transdermal compared to immediate release oral oxybutynin handling of patients with urge urinary incontinence. J Urol. 2001;166:140–5.

3. Dmochowski RR, Sand PK, Zinner NR, Gittelman MC, Davila GW, Sanders SW. Transdermal Oxybutynin Study Grouping. Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine vesus placebo in previously treated patients with urge and mixed urinary incontinence. Urology. 2003;62:237–42.

iv. Homma Y, Paick JS, Lee JG, Kawabe Thou, Japanese and Korean Tolterodine Report Group. Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive float: a randomized, placebo-controlled trial. BJU Int. 2003;92(7):741–7.

five. Sussman D, Garely A. Treatment of overactive bladder with once-daily extended-release tolterodine or oxybutynin: the antimuscarinic clinical effectiveness trial (ACET). Curr Med Res Opin. 2002;xviii:177–84, and Staskin DR. Methodologic shortcomings inherent in a mail service-hoc assay. Curr Urol Rep. 2002;iii:431–3.

STEPS drug updates cover Safety, Tolerability, Effectiveness, Toll, and Simplicity. Each update provides an independent review of a new medication past an author without financial association to the drug manufacturer.

The series coordinator is Allen F. Shaughnessy, Pharm.D., Tufts University Family Medicine Residency Program, Boston, Mass.

Copyright © 2004 by the American University of Family Physicians.
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