Changes in Voiding Patterns in Patients With MS and Extended-Release Oxybutynin

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Abstract
We evaluated the effects and tolerability of extended-release oxybutynin chloride on the voiding and catheterization frequency of multiple sclerosis (MS) patients with neurogenic bladder. This was a 12-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL). MS patients were recruited for this study from the University of Pittsburgh School of Medicine's MS clinic. Entry criteria included a postvoid residual urine volume of less than 200 mL (in noncatheterized subjects). Previous urodynamic testing was not required. Exclusion criteria included individuals with urine results indicating pyuria in the presence of a positive urine culture. These tests were repeated at six and 12 weeks. After a seven-day washout period, patients recorded episodes of voiding or catheterization and incontinence for three consecutive days. Patients received initial daily doses of 10 mg oxybutynin XL in the first week. Doses were increased at weekly or biweekly intervals to a maximum of 30 mg/d. Tolerability information was collected at each follow-up visit. Twenty of the original 23 patients completed the study. The mean age was 46.3 (range, 24 to 61). Fifteen subjects (75%) were women. Subjects reported clinical improvement with decreased urinary frequency and incontinence episodes after dosing was escalated to 30 mg/d. Seventeen patients chose a final effective dosage greater than 10 mg/d, with 13 patients taking at least 20 mg/d at the end of the study. There were no serious adverse events during the course of the study. Extended-release oxybutynin is safe and effective in MS patients with neurogenic bladder. The onset of clinical efficacy occurs within one week, and daily doses up to 30 mg may be indicated and are well tolerated. (Int J MS Care. 2002; 4: 116–119, 124)

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