From the Research
For a 66-year-old female with urge incontinence currently taking 15mg of oxybutynin, the dose should not be increased further, and consideration should be given to switching to an alternative anticholinergic medication such as tolterodine, solifenacin, or darifenacin, due to the potential for improved efficacy and reduced side effects, as suggested by the most recent and highest quality study 1. The standard dosing range for extended-release oxybutynin is 5-30mg daily, with most patients responding to 15mg daily. Since the patient is already at 15mg, maintaining this dose is reasonable if it provides adequate symptom control with tolerable side effects. However, older adults are particularly susceptible to anticholinergic side effects, including dry mouth, constipation, blurred vision, and cognitive impairment, which were highlighted in a recent review 1. Some key points to consider in managing this patient's condition include:
- Ensuring the patient takes the medication consistently and stays well-hydrated
- Practicing timed voiding and performing pelvic floor exercises to complement medication therapy, as recommended in a recent article 2
- Considering alternative medications, such as solifenacin, which has been shown to have a favorable side effect profile and improved efficacy in some studies 3, 4
- Monitoring for potential side effects and adjusting the treatment plan as needed to minimize adverse effects and optimize quality of life, in line with the findings of a recent Cochrane review 1.