Are there any contraindications to stopping oxybutynin?

No Contraindications to Stopping Oxybutynin

There are no contraindications to discontinuing oxybutynin—in fact, guidelines explicitly recommend stopping oral medications when patients achieve adequate symptom control with minimally invasive procedures, and oxybutynin carries significant adverse effects that often warrant discontinuation. 1

When to Discontinue Oxybutynin

After Successful Minimally Invasive Therapy

• The AUA/SUFU guideline explicitly states that clinicians should discontinue oral medications in patients with overactive bladder who have an appropriate response to minimally invasive procedures (botulinum toxin injection, sacral neuromodulation, or peripheral tibial nerve stimulation). 1
• If discontinuation results in symptom recurrence, then these agents should be restarted. 1
• If a patient has a good response to a minimally invasive treatment modality, there is likely no added benefit to continuing OAB medications. 1

Due to Adverse Effects

• Oxybutynin has the highest risk for discontinuation due to adverse effects among antimuscarinic medications, with a number needed to harm (NNTH) of 16 [CI, 8 to 86]. 2
• Adverse effects—dry mouth, constipation, blurred vision—occur frequently and can be sufficiently troublesome to necessitate treatment discontinuation in up to 25% of patients. 3
• In older adults, oxybutynin should be deprescribed because of significant safety concerns including vision impairment, urinary retention, constipation, cognitive decline, delirium, falls, and functional decline. 4

When Switching to Better-Tolerated Alternatives

• If inadequate response or intolerable side effects occur, consider switching to an alternative antimuscarinic with a better tolerability profile (solifenacin, darifenacin, or tolterodine). 2
• Solifenacin was associated with the lowest risk for discontinuation due to adverse effects among antimuscarinic medications. 2

Important Clinical Considerations

No Withdrawal Syndrome

• There is no evidence of withdrawal symptoms or rebound effects when stopping oxybutynin. 5, 3
• The drug can be discontinued abruptly without tapering. 5

Monitor for Symptom Recurrence

• After discontinuation, monitor for return of overactive bladder symptoms (urinary frequency, urgency, incontinence episodes). 1
• If symptoms recur after stopping following successful minimally invasive therapy, restart pharmacotherapy. 1

Reassess Treatment Periodically

• Treatment should be periodically reassessed to determine if continued therapy is necessary, especially given the high rate of adverse effects. 2

Common Pitfalls to Avoid

• Do not continue oxybutynin unnecessarily after successful minimally invasive therapy—this adds no benefit and exposes patients to ongoing adverse effects. 1
• Do not hesitate to stop oxybutynin in older adults—the anticholinergic burden contributes to cognitive decline, falls, and functional impairment in this population. 4
• Do not assume patients must remain on oxybutynin indefinitely—many patients can achieve symptom control with behavioral therapies alone after medication discontinuation. 2, 4