What is the role of oxybutynin (Ditropan IR, Ditropan XL) in the treatment of neurogenic bladder?

Updated: Dec 24, 2020
  • Author: Bradley C Gill, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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Oxybutynin chloride has both anticholinergic and direct smooth-muscle relaxant effects on urinary bladder. It provides a local anesthetic effect on irritable bladder. Urodynamic studies have shown that oxybutynin increases bladder size, decreases frequency of symptoms, and delays initial desire to void.

Ditropan XL has an innovative drug delivery system, the oral osmotic delivery system (OROS). The Ditropan XL tablet has a bilayer core that contains a drug layer and a push layer that contains osmotic components. The outer tablet is composed of a semipermeable membrane with a precision laser-drilled hole that allows the drug to be released at a constant rate.

When the drug is ingested, the aqueous environment in the GI tract causes water to enter the tablet via the semipermeable membrane at constant rate. Introduction of water inside the tablet liquifies the drug and causes the push layer to swell osmotically. As the push layer swells, it forces the drug suspension out of the hole at a constant rate over a 24-h period.

Ditropan XL achieves steady-state levels over a 24-h period. It avoids first-pass metabolism of the liver and upper GI tract to avoid cytochrome P450 enzymes. It has excellent efficacy with minimal adverse effects.

Studies have shown that oxybutynin chloride reduces incontinence episodes by 83-90%. The total continence rate has been reported to be 41-50%. The mean reduction in urinary frequency was 23%. In clinical trials, only 1% stopped taking Ditropan XL because of dry mouth, and less than 1% stopped taking Ditropan XL due to CNS adverse effects.

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