Buyse and colleagues demonstrated that DEO concentrations

after intravesical instillation were similar to oxybutynin, whereas oral therapy produced metabolite concentrations that were, on average, 7 times higher than those of oxybutynin.28 Although very effective in treating neurogenic OAB with minimal adverse effects, the inconvenience of the instillation procedure is often the reason for discontinuation of intravesical therapy. Rectal suppositories may represent an interesting option for OAB treatment, especially in patients who have an aversion to oral medication or Inhibitors,research,lifescience,medical develop allergic contact LY2835219 price sensitivity to transdermal oxybutynin. Rectal oxybutynin suppositories minimize presystemic metabolism by avoiding the hepatic first-pass effect. Despite the lower DEO levels, Winkler and Sand reported the anticholinergic adverse events of dry

mouth (48%) and constipation (14.3%), which were comparable to OXY-IR.27 Although not commercially manufactured, oxybutynin suppositories are often obtained from compounding Inhibitors,research,lifescience,medical pharmacies that specialize in customizing medications to meet Inhibitors,research,lifescience,medical the needs and preferences of each individual client. Conclusions Oxybutynin has been the most prescribed agent for the treatment of OAB. Initially limited by its tolerability and poor patient compliance, oxybutynin’s transformation into alternative delivery systems has improved its tolerability while maintaining its effectiveness. The newer delivery systems maintain steady-state characteristics and, most importantly, avoid the presystemic metabolism of oxybutynin. This reduction in DEO levels appears to improve the therapeutic tolerability of oxybutynin. Although no head-to-head trials have been performed Inhibitors,research,lifescience,medical comparing extended-release and transdermal preparations, the various oxybutynin formulations (OXY-IR, 10 mg, OXY-ER, 10 mg, OXY-TDS, and OXY-OTG) appear to have similar efficacy based on available clinical information. OXY-IR and OXY-ER have the distinct advantage of being FDA Inhibitors,research,lifescience,medical approved for use in the pediatric population. The use

of oxybutynin in the elderly remains a concern. OXY-IR was not studied in geriatric patients and has had the most reported problems with CNS, memory, and cognition side effects. Early data on transdermal formulations appear to demonstrate improved cognitive tolerability in the elderly, possibly related to the DEO concentration. Generally, transdermal delivery of oxybutynin provides significant Dipeptidyl peptidase anticholinergic tolerability advantages over the oral preparations. Of the 2 transdermal preparations, OXY-OTG has fewer dermatitis reactions and may be the optimal route of administration for this safe and effective drug in properly selected patients. Knowledge of the unique attributes of the various oxybutynin delivery systems can enhance a provider’s skill set in selecting the most appropriate oxybutynin formulation for patients.