The Pharmacokinetics of Intravesical and Oral Oxybutynin Chloride

Massad, Charlotte A.; Kogan, Barry A.; Trigo-Rocha, Flavio

doi:10.1016/s0022-5347(17)36663-6

Cited by 123 publications

(74 citation statements)

References 10 publications

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“…We focused on clinical factors such as continence situation, ecacy and side-eects of therapy. Considering side eects, Massad et al 17 and Madersbacher et al 9 described a lack of signi®cant side eects after intravesical application of oxybutynin. Green®eld et al, 11 Brendler et al 6 and Prasad et al 19 also reported no side eects.…”

Section: Discussionmentioning

confidence: 99%

Dosage escalation of intravesical oxybutynin in the treatment of neurogenic bladder patients

et al. 2000

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Objective: We prospectively analyzed the dose dependent outcome and side eects of neurogenic bladder patients with intravesical application of oxybutynin at our centre. Materials and methods: We examined the data of 32 patients with neurogenic bladders and detrusor hyperre¯exia. We registered clinical outcome, continence situation, side eects and urodynamic data of patients with (A) standard dosages of intravesical oxybutynin (0.3 mg/kg bodyweight per day) and (B) with increasing dosages in steps of 0.2 mg/kg bodyweight per day up to 0.9 mg/kg bodyweight per day. Results: We examined 32 patients aged 1 to 34 years, mean age 12 years. 21/32 patients became totally continent with the dosage (A). They showed a signi®cant (P50.01) decrease in the median max detrusor pressure (MDP) and a signi®cant (P50.01) increase in the median compliance and the median age adjusted bladder capacity (AABC). Eleven out of 32 patients remained incontinent under this dosage (A). Their median MDP, their median compliance and their median AABC remained nearly unchanged. Seven out of 11 incontinent patients under dosage (A) were treated eciently with the higher dosages (B). Their median necessary dosage escalation to achieve treatment success was 0.7 mg/kg bodyweight per day (range 0.5 to 0.9 mg/kg bodyweight per day). Their median MDP was signi®cantly (P50.05) decreased and their median compliance and median AABC were signi®cantly (P50.05) increased. Four out of 11 patients remained incontinent and showed only little improvement in urodynamic data. Two out of 11 patients with the dosage escalation (B) showed side eects at a dosage of 0.9 mg/kg bodyweight per day. Conclusions: The intravesical application of oxybutynin was a well tolerated and ecacious therapy. The topical oxybutynin therapy dosage (A) was ecient in 66% of our selected patients, the escalating dosage titration (B) could increase the eciency to 87%. Spinal Cord (2000) 38, 250 ± 254

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Section: Discussionmentioning

confidence: 99%

Dosage escalation of intravesical oxybutynin in the treatment of neurogenic bladder patients

et al. 2000

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“…34 When comparing the oral to the intravesical administration, the instillation provides a profound reduction of occurrence and severity of side effects. [34][35][36] However, after intravesical instillation there is a substantial absorption of the drug. Pharmacokinetic studies indicated that the effects on the detrusor muscle are systemic due to its absorption on the blood.…”

Section: Intravesical Oxybutyninmentioning

confidence: 99%

“…Pharmacokinetic studies indicated that the effects on the detrusor muscle are systemic due to its absorption on the blood. 36,37 Recent findings revealed that serum levels after intravesical instillation are as high as after oral intake, 38 suggesting another mechanism for less side effects after instillation. Different ratios between the drug and its metabolites as well as a reduced first pass mechanism after instillation have been discussed.…”

Section: Intravesical Oxybutyninmentioning

confidence: 99%

“…39 Target structures of the intravesical oxybutynin are the bladder afferents by a local anaesthetic effect on type C fibres 40 and the efferent cholinergic transmission by an anticholinergic effect. Several reports have been published over the years that established safety and efficacy of intravesical oxybutynin in adults [34][35][36]41 and children [42][43][44][45] with neurogenic detrusor overactivity. A dual therapy strategy combining oral and intravesical oxybutynin (15 mg three times daily) was found to be more effective than oral treatment alone.…”

Section: Intravesical Oxybutyninmentioning

confidence: 99%

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Intravesical therapy options for neurogenic detrusor overactivity

Reitz

Schurch

2004

Spinal Cord

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Objectives: This review considers intravesical treatment options of neurogenic detrusor overactivity and discusses the underlying mechanism of action, clinical safety and efficacy, and the future trends. Methods: The available literature was reviewed using medline services. Results: Oral anticholinergic drugs are widely used to treat detrusor overactivity, but they are ineffective in some patients or cause systemic side effects such as blurred vision or dry mouth. As an alternative, topical therapy strategies have been suggested to achieve a profound inhibition of the overactive detrusor and to avoid high systemic drug levels. Currently available intravesical treatment options either act on the afferent arc of the reflex such as local anaesthetics or vanilloids or on the efferent cholinergic transmission to the detrusor muscle such as intravesical oxybutynin or botulinum toxin. Although an established and effective therapy, intravesical oxybutynin is not widely used. Evidence for clinical significance of intravesical atropine and local anaesthetic is missing. Intravesical capsaicin has been shown to improve clinical and urodynamic parameters, but cause pain in some patients. The intravesical instillation of resiniferatoxin and the injection of botulinum-A toxin into the detrusor muscle are promising new options; however, randomised placebo-controlled studies to prove their safety and efficacy are still missing. Conclusion: Intravesical treatment strategies in patients with neurogenic detrusor overactivity may provide alternatives to established therapies such as oral anticholinergics. The selectivity of the intravesical treatment and the reduction or even the absence of side effects are major advantages of this topical approach.

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“…Für mehr als zwei Jahrzehnte stellte diese Therapie den Goldstandard. Das meistverwendete Anticholinergikum war über lange Zeit Oxybutynin, dessen Wirksamkeit in zahlreichen Studien bewiesen werden konnte (Amark et al, 1998a;Amark et al, 1998b;Baskin et al, 1990;Goessl et al, 1998;Hehir and Fitzpatrick, 1985;Kasabian et al, 1992;Massad et al, 1992 Oxybutynins liegt kummulativ zwischen 28% und 65% (Ferrara et al, 2001;Palmer et al, 1997). Die hyperaktive Detrusorfunktion tritt jedoch nach Absetzten einer anticholinergen Medikation unmittelbar wieder auf (Madersbacher and Murtz, 2001 …”

Section: Injektionstechnikenunclassified

Botulinumtoxin in der Urologie

Schulte-Baukloh

Knispel

2004

Urologe [A]

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The Pharmacokinetics of Intravesical and Oral Oxybutynin Chloride

Cited by 123 publications

References 10 publications

Dosage escalation of intravesical oxybutynin in the treatment of neurogenic bladder patients

Dosage escalation of intravesical oxybutynin in the treatment of neurogenic bladder patients

Intravesical therapy options for neurogenic detrusor overactivity

Botulinumtoxin in der Urologie

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