The tricyclic antidepressant imipramine hydrochloride
p. 240 can be considered for children who have not
responded to all other treatments and have undergone
specialist assessment, however relapse is common after
withdrawal and children and their carers should be aware of
the dangers of overdose. Initial treatment should continue
for 3 months; further courses can be considered following a
medical review every 3 months. Tricyclic antidepressants
should be withdrawn gradually.h
Useful Resources
Bedwetting in under 19 s. National Institute for Health and
Care Excellence. Clinical guideline CG 111. October 2010.
http://www.nice.org.uk/guidance/cg 111
ANTIMUSCARINICS
Antimuscarinics (systemic) f
lCONTRA-INDICATIONSGastro-intestinal obstruction.
intestinal atony.myasthenia gravis (but some
antimuscarinics may be used to decrease muscarinic side-
effects of anticholinesterases).paralytic ileus.pyloric
stenosis.severe ulcerative colitis.significant bladder
outflow obstruction.toxic megacolon.urinary retention
lCAUTIONSArrhythmias (may be worsened).autonomic
neuropathy.cardiac insufficiency (due to association with
tachycardia).cardiac surgery (due to association with
tachycardia).children (increased risk of side-effects).
conditions characterised by tachycardia.congestive heart
failure (may be worsened).coronary artery disease (may be
worsened).diarrhoea.gastro-oesophageal reflux disease.
hiatus hernia with reflux oesophagitis.hypertension.
hyperthyroidism (due to association with tachycardia).
individuals susceptible to angle-closure glaucoma.pyrexia
.ulcerative colitis
lSIDE-EFFECTS
▶Common or very commonConfusion.constipation.
dizziness.drowsiness.dry mouth.dyspepsia.flushing.
headache.nausea.palpitations.skin reactions.
tachycardia.urinary disorders.vision disorders.vomiting
▶UncommonAngioedema
lPATIENT AND CARER ADVICE
Driving and skilled tasksAntimuscarinics can affect the
performance of skilled tasks (e.g. driving).
eiiiiFabove
Oxybutynin hydrochloride
lINDICATIONS AND DOSE
Urinary frequency|Urinary urgency|Urinary incontinence
|Neurogenic bladder instability
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 2–4 years: 1. 25 – 2. 5 mg 2 – 3 times a day
▶Child 5–11 years:Initially 2. 5 – 3 mg twice daily,
increased to 5 mg 2 – 3 times a day
▶Child 12–17 years:Initially 5 mg 2 – 3 times a day,
increased if necessary up to 5 mg 4 times a day
▶BY INTRAVESICAL INSTILLATION
▶Child 2–17 years: 5 mg 2 – 3 times a day
▶BY MOUTH USING MODIFIED-RELEASE TABLETS
▶Child 5–17 years:Initially 5 mg once daily, adjusted in
steps of 5 mg every week, adjusted according to
response; maximum 15 mg per day
Nocturnal enuresis associated with overactive bladder
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 5–17 years: 2. 5 – 3 mg twice daily, increased to
5 mg 2 – 3 times a day, last dose to be taken before
bedtime▶BY MOUTH USING MODIFIED-RELEASE TABLETS
▶Child 5–17 years:Initially 5 mg once daily, adjusted in
steps of 5 mg every week, adjusted according to
response; maximum^15 mg per day
DOSE EQUIVALENCE AND CONVERSION
▶Patients taking immediate-release oxybutynin may be
transferred to the nearest equivalent daily dose of
Lyrinel®XLlUNLICENSED USENot licensed for use in children under
5 years. Intravesical instillation not licensed for use in
children.
lCAUTIONSAcute porphyrias p. 603
lINTERACTIONS→Appendix 1 : oxybutynin
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonDiarrhoea.dry eye
▶UncommonAbdominal discomfort.appetite decreased.
dysphagia.urticaria
SPECIFIC SIDE-EFFECTS
▶Frequency not known
Anxiety.arrhythmia.cognitive disorder.depressive
symptom.disorientation.drug dependence.
gastrointestinal disorders.glaucoma.hallucination.heat
stroke.hypohidrosis.mydriasis.nightmare.paranoia.
photosensitivity reaction.seizure.urinary tract infection
lPREGNANCYManufacturers advise avoid unless
essential—toxicity inanimalstudies.
lBREAST FEEDINGManufacturers advise avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTManufacturer advises caution.
lRENAL IMPAIRMENTManufacturer advises caution.
lPRESCRIBING AND DISPENSING INFORMATIONThe need for
therapy for urinary indications should be reviewed soon
after it has been commenced and then at regular intervals;
a response usually occurs within 6 months but may take
longer.
Intravesical instillation may be available from‘special-
order’manufacturers or specialist importing companies.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Oxybutynin for daytime urinary
symptomswww.medicinesforchildren.org.uk/oxybutynin-for-
daytime-urinary-symptomslMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution, bladder
irrigation
Modified-release tablet
CAUTIONARY AND ADVISORY LABELS3, 25
▶Lyrinel XL(Janssen-Cilag Ltd)
Oxybutynin hydrochloride 5 mgLyrinel XL 5 mg tablets|
30 tabletP£ 13. 77 DT = £ 13. 77
Oxybutynin hydrochloride 10 mgLyrinel XL 10 mg tablets|
30 tabletP£ 27. 54 DT = £ 27. 54
Tablet
CAUTIONARY AND ADVISORY LABELS 3
▶Oxybutynin hydrochloride (Non-proprietary)
Oxybutynin hydrochloride 2.5 mgOxybutynin 2. 5 mg tablets|
56 tabletP£ 14. 40 DT = £ 0. 84 | 84 tabletP£ 3. 84 – £ 21. 60
Oxybutynin hydrochloride 3 mgOxybutynin 3 mg tablets|
56 tabletP£ 16. 80 DT = £ 16. 80
Oxybutynin hydrochloride 5 mgOxybutynin 5 mg tablets|
56 tabletP£ 23. 40 DT = £ 1. 19 | 84 tabletP£ 4. 75 – £ 20. 77
▶Cystrin(Zentiva)
Oxybutynin hydrochloride 5 mgCystrin 5 mg tablets|
84 tabletP£ 21. 99
▶Ditropan(Sanofi)
Oxybutynin hydrochloride 2.5 mgDitropan 2. 5 mg tablets|
84 tabletP£ 1. 60
Oxybutynin hydrochloride 5 mgDitropan 5 mg tablets|
84 tabletP£ 2. 90BNFC 2018 – 2019 Urinary frequency, enuresis, and incontinence 489
Genito-urinary system7