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Summary of Symptoms

Dry mouth
Oxybutynin may cause dry mouth in 71.4% of people.
Detrol LA may cause dry mouth in 19.7% to 39.5% of people.
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to dry mouth
Fast fluttery heartbeat
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to fast fluttery heartbeat
Oxybutynin may cause symptoms that are related to fast fluttery heartbeat
Detrol LA may cause symptoms that are related to fast fluttery heartbeat
Memory loss
Oxybutynin may cause memory loss.
Detrol LA may cause memory loss (tended to improve when drug was stopped).
Oxybutynin and Detrol LA in combination may cause memory loss.
Short-term memory loss
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to short-term memory loss
Oxybutynin may cause a symptom that is related to short-term memory loss
Detrol LA may cause a symptom that is related to short-term memory loss

       
 
Dry mouth
Oxybutynin may cause dry mouth in 71.4% of people.

This drug may also cause the following symptoms that are related to dry mouth:

  • Dry nasal passages in 2% to 5% of people
  • Anticholinergic effects
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Note: Original Source for Medical Professionals
Gastrointestinal side effects have been reported the most frequently. These have included dry mouth (71.4%), constipation (12.6%), nausea (10.1%), dyspepsia (7%), diarrhea (5%), flatulence (2% to less than 5%), decreased GI motility (2% to less than 5%), and gastroesophageal reflux. At least one case of vomiting has been reported in a clinical study.

Reports of moderate to severe dry mouth was significantly lower in the group of people taking oxybutynin extended-release form in a study, at the same daily dose, comparing it to oxybutynin immediate-release. The reported incidence of dry mouth with the extended-release formulation is lower with the use of lower daily doses. Dry mouth has been mentioned as the primary reason given by patients for discontinuation of therapy.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using oxybutynin transdermal and call your doctor at once if you have any of these serious side effects: fever with hot, dry skin; uneven heart rate; pain, burning, or other difficulty when urinating; or severe itching, burning, or blistering that does not clear up within several hours after removing the skin patch. Less serious side effects may include: mild skin itching, burning, redness, or discoloration where a patch was worn; dizziness, drowsiness, weakness; blurred vision; dry mouth; warmth, tingling, or redness under your skin; nausea, vomiting, stomach pain; constipation or diarrhea; dry eyes; stuffy nose; back pain; feeling restless; or sleep problems (insomnia). This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other side effects including asthenia, taste perversion, and dry nasal and sinus mucous membranes have been reported in 2% to less than 5% of patients. Flushing and fever have also been reported.

Oxybutynin exerts anticholinergic effects and its use is contraindicated in patients with untreated angle closure glaucoma. It is contraindicated in patients with lower urinary obstruction due to the risk of urinary retention, in gastrointestinal (GI) obstructions such as pyloric or duodenal obstruction, or ileus, achalasia, GI hemorrhage, megacolon, toxic megacolon associated with ulcerative colitis, or severe colitis. Oxybutynin is contraindicated during acute hemorrhage associated with an unstable cardiovascular condition.

Oxybutynin is associated with anticholinergic central nervous system (CNS) effects. A variety of CNS anticholinergic effects have been observed, including hallucinations, agitation, confusion and somnolence. Patients should be monitored for signs of anticholinergic CNS effects, particularly in the first few months after beginning therapy or increasing the dose. A dose reduction or drug discontinuation should be considered if a patient experiences anticholinergic CNS effects.

REFERENCE +

  1. Oxybutynin-induced reflux esophagitis. Lee M, Sharifi R DICP 1990;24:583-5.
  2. Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence. Gleason DM, Susset J, White C, Munoz DR, Sand PK Urology 1999;54:420-3.
  3. Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate. Iselin CE, Schmidlin F, Borst F, Rohner S, Graber P Br J Urol 1997;79:915-9.
  4. The urodynamic and subjective results of treatment of detrusor instability with oxybutynin chloride. Moisey CU, Stephenson TP, Brendler CB Br J Urol 1980;52:472-5.
  5. Tolterodine, a new antimuscarinic agent: as effective but better tolerated than oxybutynin in patients with an overactive bladder. Abrams P, Freeman R, Anderstrom C, Mattiasson A Br J Urol 1998;81:801-10.
  6. Oxybutynin hydrochloride (3 mg) in the treatment of women with idiopathic detrusor instability. Moore KH, Hay DM, Imrie AE, Watson A, Goldstein M Br J Urol 1990;66:479-85.
  7. Product Information. Oxytrol (oxybutynin). Anonymous Watson Laboratories Inc, Corona, CA.
  8. Product Information. Ditropan (oxybutynin). Anonymous Hoechst Marion-Roussel Inc, Kansas City, MO. PROD;
  9. Oxybutynin Chloride (Ditrophan)--clinical uses and limitations. Brooks ME, Braf ZF Paraplegia 1980;18:64-8.
  10. Randomized, double-blind, multicenter trial on treatment of frequency, urgency and incontinence related to detruso hyperactivity: oxybutynin versus propantheline versus placebo. Thuroff JW, Bunke B, Ebner A, Faber P, de Geeter P, Hannappel J, Heidler H, Madersbacher H, Melchior H, Schafer W, et al J Urol 1991;145:813-6;disc. 816-7.
  11. The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study [se comments. Tapp AJ, Cardozo LD, Versi E, Cooper D Br J Obstet Gynaecol 1990;97:521-6.
  12. Idiopathic bladder hyperactivity treated with Ditropan (oxybutynin chloride). Nagy F, Hamvas A, Frang D Int Urol Nephrol 1990;22:519-24.
  13. Clinical evaluation of oxybutynin chloride. Hock CW Curr Ther Res Clin Exp 1967;9:437-40.
  14. Oxybutynin hydrochloride in the management of detrusor instability. Primus G, Pummer K Int Urol Nephrol 1990;22:243-8.
  15. Dry mouth with conventional and controlled-release oxybutynin in urinary incontinence. Versi E, Appell R, Mobley D, Patton W, Saltzstein D Obstet Gynecol 2000;95:718-21.
 
       
 
Dry mouth
Detrol LA (tolterodine) may cause dry mouth in 19.7% to 39.5% of people.

This drug may also cause the following symptoms that are related to dry mouth:

  • Anticholinergic effects
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Note: Original Source for Medical Professionals
Gastrointestinal side effects reported the most frequently have included dry mouth (19.7% to 39.5%). Dyspepsia, constipation, abdominal pain, and flatulence have been reported in 1% to 10% of patients. Diarrhea (1.8%), nausea (1.2%), and gastroesophageal reflux (1%) have been reported. Decreased motility and GI hemorrhage have been reported during postmarketing experience.

Most reports of dry mouth were mild to moderate in intensity. Severe dry mouth was reported during therapy with tolterodine by 1% to 5% of patients in several large, placebo controlled studies.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tolterodine and call your doctor at once if you have any of these serious side effects: chest pain, fast or uneven heart rate; feeling short of breath, even with mild exertion; swelling, rapid weight gain; confusion, hallucinations; urinating less than usual or not at all; or painful or difficult urination. Less serious side effects may include: dry mouth, dry eyes; blurred vision; dizziness, drowsiness; constipation or diarrhea; stomach pain or upset; joint pain; or headache. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General side effects reported during postmarketing experience have included hallucinations. Most of the side effects of tolterodine are extensions of its pharmacologic activity and are anticholinergic in nature. In clinical trials, 8% of patients discontinued treatment due to adverse events. Among the most common complaints leading to discontinuation was headache, which occurred in 11% of patients.

REFERENCE +

  1. Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Khullar V, Hill S, Laval KU, Schiotz HA, Jonas U, Versi E Urology 2004;64:269-74; discussion 274-5.
  2. Tolterodine in the treatment of overactive bladder: Analysis of the pooled Phase II efficacy and safety data. Larsson G, Hallen B, Nilvebrant L Urology 1999;53:990-8.
  3. A comparison of the effects on saliva output of oxybutynin chloride and tolterodine tartrate. Chancellor MB, Appell RA, Sathyan G, Gupta SK Clin Ther 2001;23:753-60.
  4. Tolterodine use for symptoms of overactive bladder. Ruscin JM, Morgenstern NE Ann Pharmacother 1999;33:1073-82.
  5. Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity. Millard R, Tuttle J, Moore K, Susset J, Clarke B, Dwyer P, Davis BE J Urol 1999;161:1551-5.
  6. Tolterodine, a new antimuscarinic drug for treatment of bladder overactivity. Guay DR Pharmacotherapy 1999;19:267-80.
  7. Benefit-risk assessment of tolterodine in the treatment of overactive bladder in adults. Garely AD, Burrows L Drug Saf 2004;27:1043-57.
  8. Product Information. Detrol (tolterodine). Anonymous Pharmacia and Upjohn, Kalamazoo, MI. PROD;
 
       
 
Dry mouth
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to dry mouth:
  • Anticholinergic effects.
  • Dry nasal passages
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The risk of the following side effects may be increased: tardive dyskinesia or ileus. This medication combination can result in abnormal regulation of body temperature with unusually high fevers (hyperthermia). Combining two drugs with "anticholinergic" properties may cause "anticholinergic intoxication syndrome" which presents with blurred vision, dry mucous membranes, flushed face, fever, rapid heartbeats, trouble urinating, hallucinations, abnormal jerking movements, and seizures. Use of oxybutynin (oxybutynin) and Detrol LA (tolterodine) can increase the chance of developing a chronic condition called "tardive dyskinesia", which is caused by long-term use of anti-psychosis medications. Signs of tardive dyskinesia include: abnormal movements or jerking of the face, tongue, jaw, trunk, arms, and legs; grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking
.

This drug combination can increase the risk of developing symptoms of drug toxicity/overdose. Notify your physician if any of the following signs of drug overdose/toxicity develop: fever, abdominal pain, hallucinations, blurred vision or heat intolerance. Avoid activities that require mental alertness (driving, operating machinery, etc.), unless you have tried these medications and found that they do not cause drowsiness. A lower dose of the anticholinergic may be required when these medications are taken together.
Hide SOURCE +

Note: Original Source for Medical Professionals
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.

MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse effects develop.

REFERENCE +

  1. Heat stroke in phenothiazine-treated patients: a report of three fatalities. Zelman S, Guillan R Am J Psychiatry 1970;126:1787-90.
  2. Anticholinergic psychosis in a patient receiving usual doses of haloperidol. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA Clin Pharm 1983;2:174-8.
  3. Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated. Mann SC, Boger WP Am J Psychiatry 1978;135:1097-100.
  4. Delirium and stereotypy from anticholinergic antiparkinson drugs. Kulik AV, Wilbur R Prog Neuropsychopharmacol Biol Psychiatry 1982;6:75-82.
  5. Product Information. Artane (trihexyphenidyl). Anonymous Lederle Laboratories, Wayne, NJ. PROD;
  6. Drug-induced heat stroke. Stadnyk AN, Glezos JD Can Med Assoc J 1983;128:957-9.
  7. Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]. Cohen MA, Alfonso CA, Mosquera M Am J Psychiatry 1994;151:619-20.
  8. Product Information. Cogentin (benztropine). Anonymous Merck & Co, Inc, West Point, PA. PROD;
  9. The anticholinergic intoxication syndrome: diagnosis and treatment. Johnson AL, Hollister LE, Berger PA J Clin Psychiatry 1981;42:313-7.
  10. Interaction between some anticholinergic agents and phenothiazines. Gershon S, Neubauer H, Sundland DM Clin Pharmacol Ther 1965;6:749-56.
  11. Drug-induced heat stroke. Sarnquist F, Larson CP Jr Anesthesiology 1973;39:348-50.
  12. Fatal drug-induced heat stroke. Forester D JACEP 1978;7:243-4.
  13. Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs. Lee BS J Clin Psychiatry 1986;47:571.
  14. Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases. Warnes H, Lehmann HE, Ban TA Can Med Assoc J 1967;96:1112-3.
  15. Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia. Moreau A, Jones BD, Banno V Can J Psychiatry 1986;31:339-41.
 
       
 
       
 
Fast fluttery heartbeat (heart palpitations)
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to fast fluttery heartbeat:
  • Anticholinergic poisoning syndrome.
  • Fast pulse/rapid heart rate
  • Irregular/abnormal heart rate
Hide MORE...
The risk of the following side effects may be increased: tardive dyskinesia or ileus. This medication combination can result in abnormal regulation of body temperature with unusually high fevers (hyperthermia). Combining two drugs with "anticholinergic" properties may cause "anticholinergic intoxication syndrome" which presents with blurred vision, dry mucous membranes, flushed face, fever, rapid heartbeats, trouble urinating, hallucinations, abnormal jerking movements, and seizures. Use of oxybutynin (oxybutynin) and Detrol LA (tolterodine) can increase the chance of developing a chronic condition called "tardive dyskinesia", which is caused by long-term use of anti-psychosis medications. Signs of tardive dyskinesia include: abnormal movements or jerking of the face, tongue, jaw, trunk, arms, and legs; grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking
.

This drug combination can increase the risk of developing symptoms of drug toxicity/overdose. Notify your physician if any of the following signs of drug overdose/toxicity develop: fever, abdominal pain, hallucinations, blurred vision or heat intolerance. Avoid activities that require mental alertness (driving, operating machinery, etc.), unless you have tried these medications and found that they do not cause drowsiness. A lower dose of the anticholinergic may be required when these medications are taken together.
Hide SOURCE +

Note: Original Source for Medical Professionals
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.

MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse effects develop.

REFERENCE +

  1. Heat stroke in phenothiazine-treated patients: a report of three fatalities. Zelman S, Guillan R Am J Psychiatry 1970;126:1787-90.
  2. Anticholinergic psychosis in a patient receiving usual doses of haloperidol. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA Clin Pharm 1983;2:174-8.
  3. Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated. Mann SC, Boger WP Am J Psychiatry 1978;135:1097-100.
  4. Delirium and stereotypy from anticholinergic antiparkinson drugs. Kulik AV, Wilbur R Prog Neuropsychopharmacol Biol Psychiatry 1982;6:75-82.
  5. Product Information. Artane (trihexyphenidyl). Anonymous Lederle Laboratories, Wayne, NJ. PROD;
  6. Drug-induced heat stroke. Stadnyk AN, Glezos JD Can Med Assoc J 1983;128:957-9.
  7. Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]. Cohen MA, Alfonso CA, Mosquera M Am J Psychiatry 1994;151:619-20.
  8. Product Information. Cogentin (benztropine). Anonymous Merck & Co, Inc, West Point, PA. PROD;
  9. The anticholinergic intoxication syndrome: diagnosis and treatment. Johnson AL, Hollister LE, Berger PA J Clin Psychiatry 1981;42:313-7.
  10. Interaction between some anticholinergic agents and phenothiazines. Gershon S, Neubauer H, Sundland DM Clin Pharmacol Ther 1965;6:749-56.
  11. Drug-induced heat stroke. Sarnquist F, Larson CP Jr Anesthesiology 1973;39:348-50.
  12. Fatal drug-induced heat stroke. Forester D JACEP 1978;7:243-4.
  13. Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs. Lee BS J Clin Psychiatry 1986;47:571.
  14. Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases. Warnes H, Lehmann HE, Ban TA Can Med Assoc J 1967;96:1112-3.
  15. Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia. Moreau A, Jones BD, Banno V Can J Psychiatry 1986;31:339-41.
 
       
 
Fast fluttery heartbeat (heart palpitations)
Oxybutynin may cause the following symptoms that are related to fast fluttery heartbeat:
  • Coronary artery disease.
  • Fast pulse/rapid heart rate in 2% to 5% of people
  • Heart palpitations in 2% to 5% of people
  • Irregular/abnormal heart rate
  • Overactive thyroid
  • QT prolongation
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Note: Original Source for Medical Professionals
Cardiovascular side effects including palpitations, peripheral edema, tachycardia, and vasodilatation have been reported in 2% to less than 5% of patients. Oxybutynin can aggravate symptoms of hypertension, coronary insufficiency, congestive heart failure, and cardiac arrhythmias. Hypotension has also been reported. QT interval prolongation has been reported postmarketing.

Metabolic side effects have included dehydration and aggravation of hyperthyroidism symptoms.

Oxybutynin exerts anticholinergic effects and its use is contraindicated in patients with untreated angle closure glaucoma. It is contraindicated in patients with lower urinary obstruction due to the risk of urinary retention, in gastrointestinal (GI) obstructions such as pyloric or duodenal obstruction, or ileus, achalasia, GI hemorrhage, megacolon, toxic megacolon associated with ulcerative colitis, or severe colitis. Oxybutynin is contraindicated during acute hemorrhage associated with an unstable cardiovascular condition.

 
       
 
Fast fluttery heartbeat (heart palpitations)
Detrol LA (tolterodine) may cause the following symptoms that are related to fast fluttery heartbeat:
  • Fast pulse/rapid heart rate (uncommon).
  • Heart palpitations
  • Irregular heartbeat - atrial fibrillation
  • QT prolongation
  • Slow heart rate
  • Ventricular arrhythmia
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Note: Original Source for Medical Professionals
Tolterodine is contraindicated in patients with urinary retention, gastric retention, or uncontrolled narrow-angle glaucoma. Therapy with tolterodine should be administered cautiously in patients with significant bladder outflow obstruction, decreased gastrointestinal motility, or gastrointestinal obstruction (e.g., pyloric stenosis) because of the risk of urinary and gastric retention.

Caution should be used when administering tolterodine to patients with congenital or acquired QT prolongation or patients who are taking Class IA antiarrhythmic medications. In studies using the immediate release tablets, the effect of tolterodine on the QT interval appeared greater for 8 mg/day (twice the therapeutic dose) compared to 4 mg/day and was more pronounced in CYP450 2D6 poor metabolizers than extensive metabolizers.

Cardiovascular side effects have infrequently included hypertension or minor increases in heart rate. Peripheral edema has been reported in 1% of patients. Tachycardia, peripheral edema, chest pain, ventricular arrhythmia, atrial fibrillation, cardiac failure, palpitations, bradycardia, collapse, and transient ischemic attacks have been reported during postmarking experience.

REFERENCE +

  1. Tolterodine - A new bladder selective muscarinic recepor antagonist: preclinical pharmacological and clinical data. Nilvebrant L, Hallen B, Larsson G Life Sci 1997;60:1129-36.
  2. Tolterodine, a new antimuscarinic drug for treatment of bladder overactivity. Guay DR Pharmacotherapy 1999;19:267-80.
  3. Benefit-risk assessment of tolterodine in the treatment of overactive bladder in adults. Garely AD, Burrows L Drug Saf 2004;27:1043-57.
  4. Tolterodine in the treatment of overactive bladder: Analysis of the pooled Phase II efficacy and safety data. Larsson G, Hallen B, Nilvebrant L Urology 1999;53:990-8.
  5. Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity. Millard R, Tuttle J, Moore K, Susset J, Clarke B, Dwyer P, Davis BE J Urol 1999;161:1551-5.
 
       
 
       
 
Memory loss
Oxybutynin may cause memory loss.
Hide SOURCE +

Note: Original Source for Medical Professionals
Nervous system side effects including dizziness (15.6%), somnolence (12.6%), headache (6%), confusion (2% to less than 5%), insomnia (2% to less than 5%), nervousness (2% to less than 5%), convulsions (2% to less than 5%), heat stroke, paralysis, coma, and CNS excitation have been reported. Memory impairment has been reported postmarketing.

REFERENCE +

  1. Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate. Iselin CE, Schmidlin F, Borst F, Rohner S, Graber P Br J Urol 1997;79:915-9.
  2. Product Information. Ditropan (oxybutynin). Anonymous Hoechst Marion-Roussel Inc, Kansas City, MO. PROD;
  3. Influences of trospium chloride and oxybutynin on quantitative EEG in healthy volunteers. Pietzko A, Dimpfel W, Schwantes U, Topfmeier P Eur J Clin Pharmacol 1994;47:337-43.
  4. Oxybutynin Chloride (Ditrophan)--clinical uses and limitations. Brooks ME, Braf ZF Paraplegia 1980;18:64-8.
  5. Exaggerated neurological side-effects of oral and intravesical oxybutynin in a patient with multiple sclerosis [letter. Vaidyanathan S, Krishnan KR, Soni BM, Fraser MH Spinal Cord 1997;35:190-1.
  6. Oxybutynin hydrochloride in the management of detrusor instability. Primus G, Pummer K Int Urol Nephrol 1990;22:243-8.
  7. Idiopathic bladder hyperactivity treated with Ditropan (oxybutynin chloride). Nagy F, Hamvas A, Frang D Int Urol Nephrol 1990;22:519-24.
  8. Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence. Gleason DM, Susset J, White C, Munoz DR, Sand PK Urology 1999;54:420-3.
  9. Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride. Katz IR, Sands LP, Bilker W, DiFilippo S, Boyce A, D'Angelo K J Am Geriatr Soc 1998;46:8-13.
  10. The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study [se comments. Tapp AJ, Cardozo LD, Versi E, Cooper D Br J Obstet Gynaecol 1990;97:521-6.
  11. Oxybutynin hydrochloride (3 mg) in the treatment of women with idiopathic detrusor instability. Moore KH, Hay DM, Imrie AE, Watson A, Goldstein M Br J Urol 1990;66:479-85.
  12. Oxybutynin and cognitive dysfunction [see comments]. Donnellan CA, Fook L, McDonald P, Playfer JR BMJ 1997;315:1363-4.
  13. Oxybutynin-induced heatstroke in an elderly patient. Adubofour KO, Kajiwara GT, Goldberg CM, King-Angell JL Ann Pharmacother 1996;30:144-7.
 
       
 
Memory loss
Detrol LA (tolterodine) may cause memory loss (tended to improve when drug was stopped).
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Note: Original Source for Medical Professionals
Nervous system side effects including headache, vertigo or dizziness, and fatigue have been reported in 1% to 10% of patients. Somnolence (0.4% to 10%), asthenia (3.6%), insomnia (0.4% to 1.6%), nervousness (1%), confusion (less than 1%), and hallucinations (less than 1%) have been reported. Syncope, convulsions, disorientation, memory impairment, and aggravation of symptoms of dementia (e.g., confusion, disorientation, and delusion) have been reported during postmarketing experience.

Reports of aggravation of symptoms of dementia (e.g., confusion, disorientation, and delusion) have been reported after tolterodine therapy was initiated in patients taking cholinesterase inhibitors for the treatment of dementia. A 73-year-old female presented with a two-year history of decreased short-term memory and vivid hallucinations of deceased relatives that occurred only during nighttime sleep; she awoke regularly to converse with these relatives. The symptoms began several weeks after taking tolterodine (2 mg twice daily) for urinary incontinence. These hallucinations did not distress the patient and resolved after three months of donepezil treatment. Her memory impairment improved after tolterodine was discontinued for several months. It recurred after tolterodine therapy was restarted.

REFERENCE +

  1. Transient memory impairment and hallucinations associated with tolterodine use. Tsao JW, Heilman KM N Engl J Med 2003;349:2274-5.
  2. Central nervous system safety of anticholinergic drugs for the treatment of overactive bladder in the elderly. Scheife R, Takeda M Clin Ther 2005;27:144-53.
  3. Tolterodine use for symptoms of overactive bladder. Ruscin JM, Morgenstern NE Ann Pharmacother 1999;33:1073-82.
  4. Product Information. Detrol (tolterodine). Anonymous Pharmacia and Upjohn, Kalamazoo, MI. PROD;
  5. Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Khullar V, Hill S, Laval KU, Schiotz HA, Jonas U, Versi E Urology 2004;64:269-74; discussion 274-5.
  6. Benefit-risk assessment of tolterodine in the treatment of overactive bladder in adults. Garely AD, Burrows L Drug Saf 2004;27:1043-57.
  7. Tolterodine, a new antimuscarinic drug for treatment of bladder overactivity. Guay DR Pharmacotherapy 1999;19:267-80.
  8. Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity. Millard R, Tuttle J, Moore K, Susset J, Clarke B, Dwyer P, Davis BE J Urol 1999;161:1551-5.
 
       
 
Memory loss
Oxybutynin and Detrol LA in combination may cause memory loss.

This drug combination may also cause the following symptoms that are related to memory loss:

  • Brain dysfunction
Hide MORE...
The risk of the following side effects may be increased: tardive dyskinesia or ileus. This medication combination can result in abnormal regulation of body temperature with unusually high fevers (hyperthermia). Combining two drugs with "anticholinergic" properties may cause "anticholinergic intoxication syndrome" which presents with blurred vision, dry mucous membranes, flushed face, fever, rapid heartbeats, trouble urinating, hallucinations, abnormal jerking movements, and seizures. Use of oxybutynin (oxybutynin) and Detrol LA (tolterodine) can increase the chance of developing a chronic condition called "tardive dyskinesia", which is caused by long-term use of anti-psychosis medications. Signs of tardive dyskinesia include: abnormal movements or jerking of the face, tongue, jaw, trunk, arms, and legs; grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking
.

This drug combination can increase the risk of developing symptoms of drug toxicity/overdose. Notify your physician if any of the following signs of drug overdose/toxicity develop: fever, abdominal pain, hallucinations, blurred vision or heat intolerance. Avoid activities that require mental alertness (driving, operating machinery, etc.), unless you have tried these medications and found that they do not cause drowsiness. A lower dose of the anticholinergic may be required when these medications are taken together.
Hide SOURCE +

Note: Original Source for Medical Professionals
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.

MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse effects develop.

REFERENCE +

  1. Heat stroke in phenothiazine-treated patients: a report of three fatalities. Zelman S, Guillan R Am J Psychiatry 1970;126:1787-90.
  2. Anticholinergic psychosis in a patient receiving usual doses of haloperidol. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA Clin Pharm 1983;2:174-8.
  3. Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated. Mann SC, Boger WP Am J Psychiatry 1978;135:1097-100.
  4. Delirium and stereotypy from anticholinergic antiparkinson drugs. Kulik AV, Wilbur R Prog Neuropsychopharmacol Biol Psychiatry 1982;6:75-82.
  5. Product Information. Artane (trihexyphenidyl). Anonymous Lederle Laboratories, Wayne, NJ. PROD;
  6. Drug-induced heat stroke. Stadnyk AN, Glezos JD Can Med Assoc J 1983;128:957-9.
  7. Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]. Cohen MA, Alfonso CA, Mosquera M Am J Psychiatry 1994;151:619-20.
  8. Product Information. Cogentin (benztropine). Anonymous Merck & Co, Inc, West Point, PA. PROD;
  9. The anticholinergic intoxication syndrome: diagnosis and treatment. Johnson AL, Hollister LE, Berger PA J Clin Psychiatry 1981;42:313-7.
  10. Interaction between some anticholinergic agents and phenothiazines. Gershon S, Neubauer H, Sundland DM Clin Pharmacol Ther 1965;6:749-56.
  11. Drug-induced heat stroke. Sarnquist F, Larson CP Jr Anesthesiology 1973;39:348-50.
  12. Fatal drug-induced heat stroke. Forester D JACEP 1978;7:243-4.
  13. Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs. Lee BS J Clin Psychiatry 1986;47:571.
  14. Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases. Warnes H, Lehmann HE, Ban TA Can Med Assoc J 1967;96:1112-3.
  15. Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia. Moreau A, Jones BD, Banno V Can J Psychiatry 1986;31:339-41.
 
       
 
       
 
Short-term memory loss (memory loss for events that happened very recently)
Oxybutynin and Detrol LA in combination may cause the following symptoms that are related to short-term memory loss:
  • Brain dysfunction.
  • Memory loss
Hide MORE...
The risk of the following side effects may be increased: tardive dyskinesia or ileus. This medication combination can result in abnormal regulation of body temperature with unusually high fevers (hyperthermia). Combining two drugs with "anticholinergic" properties may cause "anticholinergic intoxication syndrome" which presents with blurred vision, dry mucous membranes, flushed face, fever, rapid heartbeats, trouble urinating, hallucinations, abnormal jerking movements, and seizures. Use of oxybutynin (oxybutynin) and Detrol LA (tolterodine) can increase the chance of developing a chronic condition called "tardive dyskinesia", which is caused by long-term use of anti-psychosis medications. Signs of tardive dyskinesia include: abnormal movements or jerking of the face, tongue, jaw, trunk, arms, and legs; grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking
.

This drug combination can increase the risk of developing symptoms of drug toxicity/overdose. Notify your physician if any of the following signs of drug overdose/toxicity develop: fever, abdominal pain, hallucinations, blurred vision or heat intolerance. Avoid activities that require mental alertness (driving, operating machinery, etc.), unless you have tried these medications and found that they do not cause drowsiness. A lower dose of the anticholinergic may be required when these medications are taken together.
Hide SOURCE +

Note: Original Source for Medical Professionals
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.

MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse effects develop.

REFERENCE +

  1. Heat stroke in phenothiazine-treated patients: a report of three fatalities. Zelman S, Guillan R Am J Psychiatry 1970;126:1787-90.
  2. Anticholinergic psychosis in a patient receiving usual doses of haloperidol. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA Clin Pharm 1983;2:174-8.
  3. Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated. Mann SC, Boger WP Am J Psychiatry 1978;135:1097-100.
  4. Delirium and stereotypy from anticholinergic antiparkinson drugs. Kulik AV, Wilbur R Prog Neuropsychopharmacol Biol Psychiatry 1982;6:75-82.
  5. Product Information. Artane (trihexyphenidyl). Anonymous Lederle Laboratories, Wayne, NJ. PROD;
  6. Drug-induced heat stroke. Stadnyk AN, Glezos JD Can Med Assoc J 1983;128:957-9.
  7. Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]. Cohen MA, Alfonso CA, Mosquera M Am J Psychiatry 1994;151:619-20.
  8. Product Information. Cogentin (benztropine). Anonymous Merck & Co, Inc, West Point, PA. PROD;
  9. The anticholinergic intoxication syndrome: diagnosis and treatment. Johnson AL, Hollister LE, Berger PA J Clin Psychiatry 1981;42:313-7.
  10. Interaction between some anticholinergic agents and phenothiazines. Gershon S, Neubauer H, Sundland DM Clin Pharmacol Ther 1965;6:749-56.
  11. Drug-induced heat stroke. Sarnquist F, Larson CP Jr Anesthesiology 1973;39:348-50.
  12. Fatal drug-induced heat stroke. Forester D JACEP 1978;7:243-4.
  13. Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs. Lee BS J Clin Psychiatry 1986;47:571.
  14. Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases. Warnes H, Lehmann HE, Ban TA Can Med Assoc J 1967;96:1112-3.
  15. Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia. Moreau A, Jones BD, Banno V Can J Psychiatry 1986;31:339-41.
 
       
 
Short-term memory loss (memory loss for events that happened very recently)
Oxybutynin may cause the following symptom that is related to short-term memory loss:
  • Memory loss
Hide SOURCE +

Note: Original Source for Medical Professionals
Nervous system side effects including dizziness (15.6%), somnolence (12.6%), headache (6%), confusion (2% to less than 5%), insomnia (2% to less than 5%), nervousness (2% to less than 5%), convulsions (2% to less than 5%), heat stroke, paralysis, coma, and CNS excitation have been reported. Memory impairment has been reported postmarketing.

REFERENCE +

  1. Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate. Iselin CE, Schmidlin F, Borst F, Rohner S, Graber P Br J Urol 1997;79:915-9.
  2. Product Information. Ditropan (oxybutynin). Anonymous Hoechst Marion-Roussel Inc, Kansas City, MO. PROD;
  3. Influences of trospium chloride and oxybutynin on quantitative EEG in healthy volunteers. Pietzko A, Dimpfel W, Schwantes U, Topfmeier P Eur J Clin Pharmacol 1994;47:337-43.
  4. Oxybutynin Chloride (Ditrophan)--clinical uses and limitations. Brooks ME, Braf ZF Paraplegia 1980;18:64-8.
  5. Exaggerated neurological side-effects of oral and intravesical oxybutynin in a patient with multiple sclerosis [letter. Vaidyanathan S, Krishnan KR, Soni BM, Fraser MH Spinal Cord 1997;35:190-1.
  6. Oxybutynin hydrochloride in the management of detrusor instability. Primus G, Pummer K Int Urol Nephrol 1990;22:243-8.
  7. Idiopathic bladder hyperactivity treated with Ditropan (oxybutynin chloride). Nagy F, Hamvas A, Frang D Int Urol Nephrol 1990;22:519-24.
  8. Evaluation of a new once-daily formulation of oxybutynin for the treatment of urinary urge incontinence. Gleason DM, Susset J, White C, Munoz DR, Sand PK Urology 1999;54:420-3.
  9. Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride. Katz IR, Sands LP, Bilker W, DiFilippo S, Boyce A, D'Angelo K J Am Geriatr Soc 1998;46:8-13.
  10. The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study [se comments. Tapp AJ, Cardozo LD, Versi E, Cooper D Br J Obstet Gynaecol 1990;97:521-6.
  11. Oxybutynin hydrochloride (3 mg) in the treatment of women with idiopathic detrusor instability. Moore KH, Hay DM, Imrie AE, Watson A, Goldstein M Br J Urol 1990;66:479-85.
  12. Oxybutynin and cognitive dysfunction [see comments]. Donnellan CA, Fook L, McDonald P, Playfer JR BMJ 1997;315:1363-4.
  13. Oxybutynin-induced heatstroke in an elderly patient. Adubofour KO, Kajiwara GT, Goldberg CM, King-Angell JL Ann Pharmacother 1996;30:144-7.
 
       
 
Short-term memory loss (memory loss for events that happened very recently)
Detrol LA (tolterodine) may cause the following symptom that is related to short-term memory loss:
  • Memory loss (tended to improve when drug was stopped)
Hide SOURCE +

Note: Original Source for Medical Professionals
Nervous system side effects including headache, vertigo or dizziness, and fatigue have been reported in 1% to 10% of patients. Somnolence (0.4% to 10%), asthenia (3.6%), insomnia (0.4% to 1.6%), nervousness (1%), confusion (less than 1%), and hallucinations (less than 1%) have been reported. Syncope, convulsions, disorientation, memory impairment, and aggravation of symptoms of dementia (e.g., confusion, disorientation, and delusion) have been reported during postmarketing experience.

Reports of aggravation of symptoms of dementia (e.g., confusion, disorientation, and delusion) have been reported after tolterodine therapy was initiated in patients taking cholinesterase inhibitors for the treatment of dementia. A 73-year-old female presented with a two-year history of decreased short-term memory and vivid hallucinations of deceased relatives that occurred only during nighttime sleep; she awoke regularly to converse with these relatives. The symptoms began several weeks after taking tolterodine (2 mg twice daily) for urinary incontinence. These hallucinations did not distress the patient and resolved after three months of donepezil treatment. Her memory impairment improved after tolterodine was discontinued for several months. It recurred after tolterodine therapy was restarted.

REFERENCE +

  1. Transient memory impairment and hallucinations associated with tolterodine use. Tsao JW, Heilman KM N Engl J Med 2003;349:2274-5.
  2. Central nervous system safety of anticholinergic drugs for the treatment of overactive bladder in the elderly. Scheife R, Takeda M Clin Ther 2005;27:144-53.
  3. Tolterodine use for symptoms of overactive bladder. Ruscin JM, Morgenstern NE Ann Pharmacother 1999;33:1073-82.
  4. Product Information. Detrol (tolterodine). Anonymous Pharmacia and Upjohn, Kalamazoo, MI. PROD;
  5. Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Khullar V, Hill S, Laval KU, Schiotz HA, Jonas U, Versi E Urology 2004;64:269-74; discussion 274-5.
  6. Benefit-risk assessment of tolterodine in the treatment of overactive bladder in adults. Garely AD, Burrows L Drug Saf 2004;27:1043-57.
  7. Tolterodine, a new antimuscarinic drug for treatment of bladder overactivity. Guay DR Pharmacotherapy 1999;19:267-80.
  8. Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity. Millard R, Tuttle J, Moore K, Susset J, Clarke B, Dwyer P, Davis BE J Urol 1999;161:1551-5.
 
       
 
 
NOTE: Just because a drug or combination of drugs can cause a symptom does not mean it is actually causing your symptom. Symptoms can be caused by medical conditions as well. Make sure that your physician is aware of any symptoms you are experiencing so he/she can work with you to determine the cause. Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health.
DISCLAIMER: Please note that the information DoubleCheckMD.com provides is intended to help individuals to work with their medical professionals and is for educational purposes only. It does not constitute medical or healthcare advice and serves to supplement, not substitute for, the expertise and judgment of a healthcare professional. In all cases individuals should consult with a physician before taking any action based on DoubleCheckMD feedback including, but not limited to ceasing taking any drug, changing diet or commencing or discontinuing any course of treatment. The information provided by DoubleCheckMD.com is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that the use of a particular drug is safe, appropriate or effective.


 
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