Second-lineDitropan / Lyrinel XL
Oxybutynin
Non-selective antimuscarinic
Legacy OAB drug — high anticholinergic burden.
Oral IROral MRTransdermal patch
First-line for
- OAB when solifenacin/tolterodine unsuitable
- Neurogenic detrusor overactivity
Mechanism
Non-selective M1-M5 antagonism plus direct smooth-muscle relaxation.
"Oxybutynin = old, oral, oxidative on cognition"
- Highest anticholinergic cognitive burden of the class
- Avoid in elderly / dementia
- MR and patch reduce peaks and dry mouth
Dosing
- IR
- 2.5–5 mg BD-TDS
- MR (Lyrinel)
- 5–15 mg OD
- Patch (Kentera)
- 36 mg patch twice weekly
Contraindications
- AbsoluteUrinary retention, narrow-angle glaucoma, myasthenia
- CautionElderly, dementia, hepatic impairment
Side effects
- Dry mouth (severe)
- Constipation, urinary retention
- Cognitive impairment, confusion
- Blurred vision
Fetal & maternal notes
- • Limited data — avoid in pregnancy unless benefits clear
Key interactions
Other anticholinergics
AvoidAdditive
Clinical pearls
- 💡 Prefer transdermal or MR to minimise cognitive load
- 💡 Deprescribe when possible in older women
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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