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oxybutynin

Sold as Oxytrol, Gelnique. Class: Drugs for urinary frequency and incontinence. First FDA approval 07/16/1975: 51 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (85/100)

Safety ×35%
A
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 100

Evidence: 46

Regulatory history: 89

Money & lawsuits: 100

Options: 100

What the FDA label says

Approved uses

Oxybutynin chloride extended-release tablets are a muscarinic antagonist indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. Oxybutynin chloride extended-release tablets are also indicated for the treatment of pediatric patients aged 6 years and older with symptoms of detrusor overactivity associated with a neurological condition (e.g., spina bifida). Oxybutynin chloride extended-release tablets are a muscarinic antagonist indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. (1) Oxybutynin chloride extended-release tablets are also indicated for the treatment of pediatric patients aged 6 years and older with symptoms of detrusor overactivity associated with a neurological condition (e.g., spina bifida). (1)

Contraindications

Oxybutynin chloride extended-release tablets are contraindicated in patients with urinary retention, gastric retention and other severe decreased gastrointestinal motility conditions, uncontrolled narrow-angle glaucoma. Oxybutynin chloride extended-release tablets are also contraindicated in patients who have demonstrated hypersensitivity to the drug substance or other components of the product. There have been reports of hypersensitivity reactions, including anaphylaxis and angiodema. Urinary retention (4) Gastric Retention (4) Uncontrolled narrow angle glaucoma (4) Known hypersensitivity to Oxybutynin chloride extended-release tablets, oxybutynin or any component of Oxybutynin chloride extended-release tablets (4)

Warnings and precautions

Angioedema: Angioedema has been reported with oxybutynin. If symptoms of angioedema occur, discontinue Oxybutynin chloride extended-release tablets immediately and initiate appropriate therapy. ( 5.1 ) Central Nervous System (CNS) effects: CNS effects have been reported with oxybutynin. If patient experiences anticholinergic CNS effects, consider dose adjustment or discontinuation of Oxybutynin chloride extended-release tablets. ( 5.2 ) Use with caution due to aggravation of symptoms: Pre-existing dementia in patients treated with cholinesterase inhibitors ( 5.2 ), Parkinson's disease ( 5.2 ), Myasthenia gravis ( 5.3 ), and Decreased gastrointestinal motility in patients with autonomic neuropathy. ( 5.4 ) Urinary Retention: Use with caution in patients with clinically significant bladder outflow obstruction because of the risk of urinary retention ( 5.5 ) Gastrointestinal Adverse Reactions: Use with caution in patients with gastrointestinal obstructive disorders or decreased intestinal motility due to risk of gastric retention. Use with caution in patients with gastroesophageal reflux or in patients concurrently taking drugs that can exacerbate esophagitis. ( 5.6 ) 5.1 Angioedema A...

Adverse reactions (label)

The most common (incidence ≥5%) adverse reactions were dry mouth, constipation, diarrhea, headache, somnolence, and dizziness. (6) To report SUSPECTED ADVERSE REACTIONS, contact AvKARE, Inc. at 1-855-361-3993 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The safety and efficacy of Oxybutynin chloride extended-release tablets (5 to 30 mg/day) was evaluated in 774 adult subjects who participated in five double-blind, controlled clinical trials. In four of the five studies, Oxybutynin chloride IR (5 to 20 mg/day in 199 subjects) was an active comparator. Adverse reactions reported by ≥ 1% of subjects are shown in Table 1. Table 1: Adverse Drug Reactions Reported by ≥ 1% of Oxybutynin chloride extended-release tablets-treated Adult Subjects in Five Double-blind, Controlled Clinical Trials of Oxybutynin chloride extended-release tablets System/Organ Class Preferred Term Oxybutynin...

Source: FDA SPL label for Oxybutynin Chloride Extended Release (Aphena Pharma Solutions - Tennessee, LLC), effective 20230531. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

34,781reports that mention this drug
34,697of those blame this drug, not another one the person was taking
53%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
6.2%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Drug Ineffective · 3,417Fatigue · 2,327Fall · 2,097Nausea · 1,724Diarrhoea · 1,591Headache · 1,555Off Label Use · 1,535Urinary Tract Infection · 1,524Pain · 1,438Dizziness · 1,435Asthenia · 1,218Constipation · 1,102Gait Disturbance · 1,080Malaise · 1,010Dyspnoea · 1,002

Reports per year

20192020202120222023202420252026
3,4943,0542,5492,3712,1311,1932,087969

781 reports blaming this drug for every million Medicare prescriptions filled, which is 0.3× the typical drug on this site. (4,235 reports in 2024–2026, against 5,422,689 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

7recall actions on file
7 / 33brand / generic applications
2label changes since 2021
NoREMS program
DateClassFirmReason
10/2023Class IIZydus Pharmaceuticals (USA) IncFailed Dissolution Specifications-out-of-specification (OOS) test results observed for dissolution at the 6 month long term time point.
10/2023Class IIZydus Pharmaceuticals (USA) IncFailed Dissolution Specifications-out-of-specification (OOS) test results observed for dissolution at the 6 month long term time point.
10/2023Class IIZydus Pharmaceuticals (USA) IncFailed Dissolution Specifications-out-of-specification (OOS) test results observed for dissolution at the 6 month long term time point.
09/2023Class IIZydus Pharmaceuticals (USA) IncFailed Dissolution Specifications
03/2019Class IIIAVKARE Inc.Failed Dissolution Specifications
02/2019Class IIILannett Company Inc.Failed Dissolution Specifications
12/2018Class IIKVK-Tech, Inc.Labeling: Wrong bar code

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

160randomized trials (PubMed)
9systematic reviews
116registered trials
38%of completed trials posted results
7%terminated or withdrawn
41%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

1,476,739Medicare Part D patients (2024)
5,422,689prescriptions filled
$21average cost per fill
$112Mtotal Medicare spend
ProductFills$/fill
Oxybutynin Chloride ER3,420,475$22
Oxybutynin Chloride2,000,706$17
Oxytrol1,434$963
Gelnique74$597

Same-class alternatives

1 drug in the same class grades a letter or more higher than oxybutynin on this site. Worth asking whether one of them would do the same job for you.

darifenacinemeproniumfesoterodineflavoxatepropiverineterodiline

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are fatigue, fall, nausea. How would we recognize and handle those?
  2. Why this one over darifenacin, emepronium, fesoterodine? What would make you pick one of those instead?
  3. What result are we expecting, by when, and what is the plan if it does not happen?
  4. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)