title: Efficacy and safety of transdermal and oral oxybutynin in children with neurogenic detrusor overactivity.
abstract: OBJECTIVE
  We evaluated the efficacy and safety of transdermal and oral oxybutynin in children with neurogenic detrusor overactivity.
  
  
  METHODS
  Children with neurogenic detrusor overactivity 6 to 15 years old and previously receiving oxybutynin were assigned randomly at a 3:1 ratio to treatment with transdermal or oral oxybutynin. Initial dosages (transdermal 1.3, 2.9 or 3.9 mg daily; oral 5, 10 or 15 mg daily), based on pre-study dosages, were adjusted after 2 weeks and then maintained for 12 weeks. The primary efficacy end point was change from baseline to last observation in average urine volume collected by clean intermittent catheterization.
  
  
  RESULTS
  A total of 57 patients were randomized to receive transdermal (41) or oral (16) oxybutynin. Safety data were available for 55 patients and efficacy data were available for 52. Mean +/- SD urine volume increased from 95 +/- 64 ml to 125 +/- 74 ml (p <0.001) with transdermal oxybutynin and from 114 +/- 75 ml to 166 +/- 92 ml (p = 0.002) with oral oxybutynin. Transdermal oxybutynin resulted in significant improvement in all measured urodynamic parameters. Similar trends and a significant increase in maximal cystometric bladder capacity were observed in the smaller oral oxybutynin group. There were 12 treatment related adverse events noted with transdermal oxybutynin (mild skin reaction) and 1 with oral oxybutynin (vasodilatation). The ratio of N-desethyloxybutynin-to-oxybutynin plasma concentrations was substantially lower with transdermal (1.4) than with oral (6.7) oxybutynin.
  
  
  CONCLUSIONS
  Transdermal oxybutynin was a well tolerated and effective alternative to oral oxybutynin in treating neurogenic detrusor overactivity in children who previously tolerated oxybutynin.
authors.affiliation: Division of Urology, University of Utah and Department of Pediatric Urology, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. patrick.cartwright@hsc.utah.edu
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Cartwright
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Coplen
authors.forename: Barry A
authors.initials: BA
authors.lastname: Kogan
authors.forename: Weining
authors.initials: W
authors.lastname: Volinn
authors.forename: Eileen
authors.initials: E
authors.lastname: Finan
authors.forename: Gary
authors.initials: G
authors.lastname: Hoel
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage*; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D008333:Mandelic Acids; D018727:Muscarinic Antagonists; C005419:oxybutynin