Oxybutynin XL

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.