Is Oxybutynin on the Beers List for the Elderly?
Yes, oxybutynin is explicitly identified on the Beers Criteria as a strongly anticholinergic medication that should be avoided in older adults due to its high risk of adverse effects including cognitive impairment, falls, constipation, urinary retention, and visual disturbances. 1
Why Oxybutynin Is Problematic in Older Adults
The American Geriatrics Society classifies oxybutynin as a high-risk anticholinergic medication that causes broad muscarinic receptor blockade, resulting in:
- Cognitive decline and delirium - The anticholinergic burden from oxybutynin adversely affects cognition and functional status, with documented cognitive impairment that may go unnoticed by patients 1, 2
- Increased fall risk - Strong anticholinergic properties contribute to sedation, impaired mobility, and injurious falls requiring emergency department visits and hospitalizations 1
- Visual impairment, urinary retention, and constipation - These anticholinergic effects are poorly tolerated in aged patients 1
- Decline in activities of daily living (ADL) scores - The Drug Burden Index demonstrates that strongly anticholinergic medications like oxybutynin are associated with functional decline 1
The Evidence Against Oxybutynin in Elderly Patients
Central nervous system penetration is highest for oxybutynin compared to other bladder antimuscarinics due to its lipophilicity, leading to greater cognitive impairment risk 3. Both immediate-release and extended-release formulations have been associated with cognitive impairment in clinical trials 3.
Research specifically concludes that oxybutynin should not be used in frail older people despite similar efficacy to other anticholinergics, because it has a higher incidence of adverse drug events, particularly significant yet unnoticed cognitive impairment 2.
Clinical Implications for Deprescribing
When conducting medication reviews in older adults, oxybutynin should be prioritized for deprescribing as part of the strategy to:
- Reduce anticholinergic burden - Patients taking multiple anticholinergic drugs experience compounded negative effects on cognition and functionality 1
- Decrease emergency department visits and hospitalizations - The liabilities associated with anticholinergic medications directly increase healthcare costs and morbidity 1
- Apply Beers Criteria systematically - The American Geriatrics Society recommends identifying and deprescribing inappropriate medications like oxybutynin at every care transition 4
Common Pitfall to Avoid
Despite oxybutynin often being recommended in guidelines and required as first-line therapy by insurance-based healthcare systems before reimbursement for newer anticholinergics, this practice shortchanges frail older people and contradicts the Beers Criteria recommendations 2. The fact that oxybutynin may be effective for overactive bladder symptoms does not justify its use when safer alternatives exist for the elderly population.