Can Higher Doses of Oxybutynin Improve Efficacy in Neurogenic Bladder?
2004; Lippincott Williams & Wilkins; Volume: 171; Issue: 2 Linguagem: Inglês
10.1097/01.ju.0000103274.38694.b1
ISSN1527-3792
AutoresNelson Bennett, Margie O’Leary, Ankur Patel, Macrina Xavier, Janet Erickson, Michael B. Chancellor,
Tópico(s)Pelvic floor disorders treatments
ResumoNo AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2004Can Higher Doses of Oxybutynin Improve Efficacy in Neurogenic Bladder? NELSON BENNETT, MARGIE O'LEARY, ANKUR S. PATEL, MACRINA XAVIER, JANET R. ERICKSON, and MICHAEL B. CHANCELLOR NELSON BENNETTNELSON BENNETT , MARGIE O'LEARYMARGIE O'LEARY , ANKUR S. PATELANKUR S. PATEL , MACRINA XAVIERMACRINA XAVIER , JANET R. ERICKSONJANET R. ERICKSON , and MICHAEL B. CHANCELLORMICHAEL B. CHANCELLOR View All Author Informationhttps://doi.org/10.1097/01.ju.0000103274.38694.b1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the efficacy and tolerability of higher dose oxybutynin chloride in patients with neurogenic bladder and multiple sclerosis, spinal cord injury or Parkinson's disease. Materials and Methods: The study design was a prospective, 12-week dose titration trial of controlled release oxybutynin (OXY-XL). A 7-day washout period was used before initiation of the starting dose of 10 mg OXY-XL. Doses of OXY-XL were increased by 5 mg at weekly intervals to a maximum dose of 30 mg per day guided by patient perception of efficacy versus side effect. Voiding diaries were completed at baseline, and weeks 6 and 12. Post-void residuals were recorded. Criteria for study admission included post-void residual less than 200 ml. Results: Of the 39 patients enrolled in the study 22 had multiple sclerosis, 10 had spinal cord injury and 7 had Parkinson's disease. There were 29 women (74%) and 10 men (26%). Within 1 week a decrease in the number of voids per day was seen in greater than 50% of the subjects. At the end of the study statistically significant decreases in the number of voids in 24 hours, episodes of nocturia and incontinence episodes were observed. Residual urine remained unchanged from 33.9 ± 7.6 ml at baseline to 51.3 ± 10.4 ml after 12 weeks at the final dose (p = 0.17). No patient experienced serious adverse events and none dropped out during the course of the 12-week study. At the end of the study 20.5% of subjects remained on 30 mg, 15.4% on 25 mg, 23.1% on 20 mg, 15.4% on 15 mg and 25.6% on 10 mg OXY-XL. Conclusions: Aggressive dosing of OXY-XL is safe and effective in patients with neurogenic bladder. Compared with nonneurogenic overactive bladder, higher doses of OXY-XL (15 mg daily or greater) were requested by 74.4% of the patients in our study. The onset of clinical efficacy can occur within 1 week, and doses up to 30 mg are well tolerated and effective in this population. References 1 : Pathophysiology of the neurogenic bladder. In: Continuum Lifelong Learning in Neurology-Neurourology. Edited by . Baltimore: Williams & Wilkins Co.1998. Google Scholar 2 : High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries. J Urol1998; 159: 965. Link, Google Scholar 3 : Urodynamics of spinal cord injury. Urol Clin North Am1996; 23: 459. Crossref, Medline, Google Scholar 4 : Contemporary urologic management of patients with spinal cord injury. Mayo Clin Proc1998; 73: 434. Google Scholar 5 : Quality of life of older adults with urinary incontinence. J Am Geriatr Soc1998; 46: 778. Google Scholar 6 : Evidence for early lower urinary tract dysfunction in clinically silent multiple sclerosis. J Urol1991; 145: 1219. Link, Google Scholar 7 : Sleep disturbance, depression, and lesion site in patients with multiple sclerosis. Arch Neurol1992; 49: 641. Google Scholar 8 : An extended-release formulation of oxybutynin chloride for the treatment of overactive urinary bladder. Clin Ther1999; 21: 634. Google Scholar 9 : Pharmacologic and potential biologic interventions to restore bladder function after spinal cord injury. Curr Opin Neurol2000; 13: 677. Google Scholar 10 : Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry1993; 56: 245. Crossref, Medline, Google Scholar 11 : Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia. J Urol1986; 135: 966. Link, Google Scholar 12 : Randomized, double-blind, multicenter trial on treatment of frequency, urgency and urge incontinence related to detrusor hyperactivity: oxybutynin versus propantheline versus placebo. J Urol1991; 145: 813. Abstract, Google Scholar 13 : Conservative therapy of frequency, urgency and urge incontinence: a double-blind clinical trial of flavoxate hydrochloride, oxybutynin chloride, emperonium bromide and placebo. World J Urol1987; 5: 57. Google Scholar 14 : Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence. Ditropan XL Study Group. Urology1999; 54: 420. Google Scholar 15 : Once daily controlled versus immediate release oxybutynin chloride for urge incontinence. J Urol1999; 161: 1809. Abstract, Google Scholar 16 : A randomized controlled trial comparing the efficacy of controlled-release oxybutynin tablets (10 mg once daily) with conventional oxybutynin tablets (5 mg twice daily) in patients whose symptoms were stabilized on 5 mg twice daily of oxybutynin. BJU Int2000; 85: 793. Crossref, Medline, Google Scholar 17 : Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. The Ditropan XL Study Group. Obstet Gynecol2000; 95: 718. Medline, Google Scholar 18 : Quantitative characterization of therapeutic index: application of mixed-effects modeling to evaluate oxybutynin dose-efficacy and dose-side effect relationships. Clin Pharmacol Ther1999; 65: 672. Crossref, Medline, Google Scholar 19 : Pharmacokinetics of an oral once-a-day controlled-release oxybutynin formulation compared with immediate-release oxybutynin. J Clin Pharmacol1999; 39: 289. Google Scholar From the Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHASHIMOTO T, NAGABUKURO H and DOI T (2018) EFFECTS OF THE SELECTIVE ACETYLCHOLINESTERASE INHIBITOR TAK-802 ON THE VOIDING BEHAVIOR AND BLADDER MASS INCREASE IN RATS WITH PARTIAL BLADDER OUTLET OBSTRUCTIONJournal of Urology, VOL. 174, NO. 3, (1137-1141), Online publication date: 1-Sep-2005. Volume 171Issue 2February 2004Page: 749-751 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsbladder, neurogenicspinal cord injuriesurinary incontinencemultiple sclerosisParkinson diseaseMetricsAuthor Information NELSON BENNETT More articles by this author MARGIE O'LEARY More articles by this author ANKUR S. PATEL More articles by this author MACRINA XAVIER More articles by this author JANET R. ERICKSON More articles by this author MICHAEL B. CHANCELLOR Financial interest and/or other relationship with OrthoMcNeil, Pfizer, ICOS, Lilly, Watson, Cook and Yamanouchi. More articles by this author Expand All Advertisement PDF downloadLoading ...
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