Antimuscarinic
Pregnancy: There are no adequate data on the use of oxybutynin in pregnant women and animal studies have shown minor reproductive toxicity; Lyrinel XL is not recommended during pregnancy. Breastfeeding: a small amount is excreted in the mother's milk and the effect on newborns/infants is unknown, so use during breastfeeding is not recommended. Fertility: reproduction studies with oral oxybutynin in the mouse, rat, hamster and rabbit showed no evidence of impaired fertility. (§4.6)
Oxybutynin XL
Brand names: Lyrinel XL, Kentera patch
Oxybutynin XL is an extended-release antimuscarinic used to treat overactive bladder with urinary urgency, frequency and urge incontinence.
Adult dose
Dose: SCOPE — ORAL PROLONGED-RELEASE (XL) TABLET ONLY; the transdermal patch route also listed on this page is a different product and is NOT covered by this source. Overactive bladder in adults: starting dose one 5 mg tablet once daily; after at least one week on 5 mg daily the dose may be increased to 10 mg once daily, with subsequent incremental increases or decreases of 5 mg/day and an interval of at least one week between dose changes
Route: Oral, prolonged-release tablet. Must be swallowed whole with the aid of liquid and must not be chewed, divided or crushed, because the tablet is formulated to provide prolonged release. May be administered with or without food.
Frequency: Once daily
Max: 20 mg/day by mouth (prolonged-release). §4.2 verbatim: 'Maximum dose: in patients requiring a higher dose, the total daily dose should not exceed 20 mg.' No transdermal figure is available from this source.
SCOPE: every figure here is from the oral prolonged-release product only. The transdermal patch named on this page is a separate product with its own SPC, which is NOT in this bundle — no patch strength, application interval or patch maximum has been published above, and none may be inferred from the oral figures. TITRATION: the aim is the maintenance dose giving an optimal balance of efficacy and tolerability; keep at least one week between dose changes. SWITCHING FROM IMMEDIATE-RELEASE OXYBUTYNIN: clinical judgement should be exercised in selecting the appropriate dose, adjusting to the minimum dose that achieves an optimal balance of efficacy and tolerability, taking into account the current immediate-release dose. MISSED DOSE: the patient should wait and take the next dose at the regular time. ELDERLY: no dosage adjustment is necessary, but oxybutynin should be used with caution in the frail elderly who may be more sensitive to its effects, and anticholinergics should be used with caution in elderly patients because of the risk of cognitive impairment. PAEDIATRIC: licensed from over 5 years of age — see paedDose; must not be used in children below 5 years, as safety and efficacy have not been established. Patients should be advised that the tablet membrane may pass through the gastrointestinal tract unchanged, which has no bearing on the efficacy of the product. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Paediatric dose
Dose: Children over the age of 5 years (oral prolonged-release tablet): initial dose 5 mg once a day, increased in 5 mg increments up to a maximum of 15 mg once a day. NOT weight-based — this is the label's own fixed paediatric dose and nothing has been scaled from the adult regimen
Route: Oral, prolonged-release tablet — swallowed whole with the aid of liquid; must not be chewed, divided or crushed
Frequency: Once daily
Max: 15 mg once a day
§4.2 Paediatric population, verbatim: 'Children over the age of 5 years — Initial dose of 5 mg once a day increased in 5 mg increments up to a maximum of 15 mg once a day. Lyrinel XL should not be used in children below age of 5 years, because safety and efficacy have not been established.' §4.8 records that safety was evaluated in one open-label active-comparator trial in which 60 paediatric subjects received doses of 10 or 15 mg/day. This is an oral prolonged-release regimen only; it says nothing about the transdermal patch, and no oral liquid/syrup is described in this SPC, so no concentration is published. Verify any paediatric use against a children's formulary.
Dose adjustments
Renal
No numeric adjustment is stated in this SPC. Oxybutynin should be given with caution in patients with renal impairment (§4.4). Urinary frequency and nocturia due to renal failure is a contraindication (§4.3).
Hepatic
No numeric adjustment is stated in this SPC. Oxybutynin should be given with caution in patients with hepatic impairment (§4.4).
Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3)
- Narrow-angle glaucoma or shallow anterior chamber (§4.3)
- Myasthenia gravis (§4.3)
- Urinary retention (§4.3)
- Gastrointestinal obstructive disorder, paralytic ileus or intestinal atony (§4.3)
- Severe ulcerative colitis (§4.3)
- Toxic megacolon (§4.3)
- Urinary frequency and nocturia due to heart or renal failure (§4.3)
- Porphyria (§4.3)
Side effects
- Dry mouth — very common (§4.8)
- Constipation, diarrhoea, nausea, vomiting, dyspepsia, abdominal pain, gastro-oesophageal reflux disease, flatulence, dysphagia — common to uncommon (§4.8)
- Headache, somnolence, dizziness, dysgeusia — common (§4.8)
- Anticholinergic CNS effects — hallucinations, agitation, confusional state, memory impairment; and more rarely psychotic disorder, anxiety, nightmares, paranoia, symptoms of depression, cognitive disorders and convulsions (§4.4, §4.8)
- Vision blurred, dry eye; angle-closure glaucoma, mydriasis and ocular hypertension (§4.8)
- Urinary tract infection; dysuria, urinary hesitation; urinary retention and residual urine (§4.8)
- Palpitations, arrhythmia, tachycardia; hypertension, flushing (§4.8)
- Dry skin, pruritus, urticaria, rash; angioedema and hypohidrosis (§4.8)
- Angioedema of the face, lips, tongue and/or larynx has been reported, in some cases after the first dose — angioedema with upper airway swelling has the potential to become life-threatening and oxybutynin should be promptly discontinued (§4.4)
- Nasal dryness, dry throat, oropharyngeal pain, cough, dysphonia, nasal congestion, throat irritation (§4.8)
- Fatigue, mucosal dryness, thirst, chest discomfort; insomnia; anorexia, decreased appetite, fluid retention (§4.8)
- Heat stroke — oxybutynin decreases sweating, so use in fever or high environmental temperatures can cause heat prostration or heat stroke (§4.4, §4.8)
- Falls; hypersensitivity and anaphylactic reaction; pseudo-obstruction in patients at risk (§4.8)
- The five adult trials underlying this profile used doses ranging from 5 to 20 mg/day in 759 adult subjects (§4.8)
Monitoring
- Anticholinergic CNS effects (hallucinations, agitation, confusion, somnolence) — monitoring recommended especially in the first few months after initiating therapy or increasing the dose; consider discontinuing or reducing the dose if they develop (§4.4)
- Visual acuity and intraocular pressure — monitor periodically during therapy, as oxybutynin can cause angle-closure glaucoma (§4.4)
- Urinary symptoms and residual urine — caution in clinically significant bladder outflow obstruction, since anticholinergics may aggravate obstruction and cause retention (§4.4)
- Treat any urinary tract infection with appropriate antibacterial therapy (§4.4)
- Cognitive function in the elderly and in pre-existing dementia treated with cholinesterase inhibitors, because of the risk of aggravating symptoms (§4.4)
Clinical monograph
How it works
It antagonises muscarinic receptors on detrusor smooth muscle, reducing involuntary bladder contractions and increasing functional bladder capacity.
Prescribing in practice
- Antimuscarinic adverse effects, including confusion and cognitive impairment, are a particular concern in frail older patients, and overall anticholinergic burden should be minimised.
- It is contraindicated in untreated narrow-angle glaucoma, significant urinary retention and certain gastrointestinal obstructive or atonic conditions.
- Use caution with other anticholinergic drugs and in those at risk of constipation, as advised in the SPC.
Monitoring
Review symptom response, anticholinergic side effects and, particularly in older people, cognitive effects after a treatment trial.
Counselling the patient
- Swallow the modified-release tablet whole without crushing or chewing.
- Dry mouth, constipation and blurred vision are common; report eye pain, confusion or difficulty passing urine.
- Combine treatment with bladder training and adequate fluid intake for best effect.
Evidence & guidelines
Antimuscarinics are recommended by NICE for overactive bladder after conservative measures such as bladder training, with attention to anticholinergic burden in older people.
Reference: NICE NG123; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
