OAB in a Difficult-to-Treat Patient With Transdermal Oxybutynin

OAB in a Difficult-to-Treat Patient With Transdermal Oxybutynin
Antimuscarinic agents, effective in relieving symptoms of overactive bladder, are associated with anticholinergic-mediated adverse events, particularly at high dosages. The outcome of a difficult-to-treat patient requiring high doses of anticholinergic therapy who was successfully treated with transdermal oxybutynin after failing oral therapies is reported.

Overactive bladder (OAB) is estimated to affect more than 16% of the U.S. population; more than one-third of these individuals also experience urge urinary incontinence (UI), the most severe symptom of OAB (Stewart et al., 2003). The prevalence of OAB with urge UI rises in older women relative to populations such as men or younger women. Overactive bladder and its symptoms can have a significant negative impact on quality of life in all of these populations (Stewart et al., 2003). Treatment options include behavioral modification techniques and pharmacotherapy (Wein, 2003). Although agents from different therapeutic classes (for example, hormonal replacement therapy and alpha adrenergic antagonists) have been used to treat the symptoms of OAB, antimuscarinics are the only class of agents currently approved for treating this disorder (Wein, 2003). The most widely prescribed are oxybutynin and tolterodine, and both are effective in decreasing the number of micturitions per day and the number of urge UI episodes (Harvey, Baker, & Wells, 2001). However, these agents and other antimuscarinics are associated with a relatively high incidence of anticholinergic adverse events (AEs), most notably dry mouth and constipation. These AEs may limit titration to effective doses in some cases as well as limit patient adherence to therapy (Wein, 2003). In this article, the case of an older woman who experienced AEs typically associated with oral anticholinergics, thus requiring alternative treatment, is examined. A transdermal formulation of oxybutynin allowed this patient to receive the higher dosage of anticholinergic therapy she required without compromising her tolerability.