Ditropan questions

[Wise Young]

Posting from Stephen212 at SpinalNurse Forum Posted on 07/01/2001 8:23 PM

Questions for Spinal Nurse:

1). To what extent is the Ditropan solution absorbed by the bladder into the blood system?

2). Is there any reason why a double concentration would be contraindicated? That is, 10mg/30cc instead of 5mg/30cc. Might the Ditropan solution irritate the mucosal lining of the bladder?

3). Is the Ditropan effective for the entire time that it's in the bladder or is its effect greatest when it's first infused? When the bladder is emptied is there a residual effect from the Ditropan solution?

4). I've noticed that air in the syringe (or catheter) can sometimes get inside the bladder. Where does it go once it's inside the bladder? Any reason for concern? I can't get my penis to burp. http://sci.rutgers.edu/forum/images/smilies/smile.gif

Thanks.

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Posted By: spinalnurse
Posted on 07/02/2001 7:54 AM

Stephen, I don't know the answers to most of your questions, but will try to get back to you after talking to some of our urology staff. I know that in studies done here with blood assays that the blood level of intravesical Ditropan was significantly less than with oral, but that there is some systemic absorbtion. The local effect on the bladder wall appears to be sustained for some time, even after the bladder is emptied, which is why most people can use it only twice daily even if they cath 6 times.

I would not recommend increasing the dose without discussing with your physician. The risk of toxic reactions should be carefully evaluated.

A small bubble of air will not hurt your bladder and is reabsorbed by the urine, but you should avoid large amounts which can cause bladder spasm.

(KLD)
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Posted By: stephen212 Profile
Posted on 07/24/2001 12:15
PM

I had my third urodynamic study in as many months and the first one to assess the effects of my new bladder program as described earlier (though I no longer take any oral meds for my bladder -- just the trans-cath infusions).

The results showed conclusively that my bladder pressures are way down and my bladder capacity is way up -- I routinely have residuals of 400+ cc's and haven't had an episode of incontinence since I began infusing my bladder with a solution of ditropan (actually, its generic equivalent -- oxybutynin chloride).

Looking through my urology chart, I noticed there were many comments saying that I was a likely candidate for an augmentation cystoplasty. NOT ANYMORE!! Even my urologist characterized the results as "a fucking miracle!" And it is.

[Wise Young]

1). To what extent is the Ditropan solution absorbed by the bladder into the blood system?
@ When Ditropan is instilled into the bladder (technically called intravesicular administration), it is absorbed by the bladder and some of it gets into the blood stream. In general, the amount that gets into the bloodstream is less than if you take the drug orally. A study recently by Stasi, et al. (I have placed a pdf file containing abstracts of studies on the subject of intravesicular administration of Ditropan at http://carecure.rutgers.edu/spinewire/Research.html) suggested that the absorption of ditropan by the bladder is limited and that one can increase the absorption by putting an electrical current through the catheter. They instilled what seems to be a relatively low concentration of Ditropan, i.e. 5 mg/100ml, into the bladder.

2). Is there any reason why a double concentration would be contraindicated? That is, 10mg/30cc instead of 5mg/30cc. Might the Ditropan solution irritate the mucosal lining of the bladder?
@ I don't know the extent to which Ditropan irritates the bladder. But, on the safe side, why not give 10 mg/60cc if you want to double the dose. Actually, even 5 mg/30ml seems a bit high to me. You may want to consult with your urologist on this matter. Note that Stasi, et al. used 5 mg/100 ml which is a much lower concentration and they then used electrical current to increase the amount of drug absorbed by the bladder.

3). Is the Ditropan effective for the entire time that it's in the bladder or is its effect greatest when it's first infused? When the bladder is emptied is there a residual effect from the Ditropan solution?
@ Given the relatively low absorption rate of Ditropan into the bladder, it makes sense that the longer you keep it there, the more will be absorbed. However, once the drug has been absorbed into the bladder, it probably continues to block acetylcholine receptors until the drug is cleared from the bladder tissues. This may take several hours.

4). I've noticed that air in the syringe (or catheter) can sometimes get inside the bladder. Where does it go once it's inside the bladder? Any reason for concern? I can't get my penis to burp.
@ As KLD pointed out, air will dissolve in urine. Over time, the air will pass out of the bladder dissolved in the urine. Because the air is lighter than fluid, if you are sitting upright, it will form a bubble at the top of the bladder. That is probably why your penis will not burp.

Wise..

[stephen212]

Wise,
Thanks for responding to my questions. The URL for the pdf file you posted containing the abstracts on intravesicular administration of Ditropan is not operational. Would you please double check it?

BTW, I'm sure you don't remember me, but many many moons ago -- June 1984 to be precise -- while you were still at NYU and I was about 8 months into my injury, you did an SEP study on me to see if I was a viable prospect for Harry Goldsmith's omentum transposition surgery that was getting so much buzz at the time (I still have a copy of the letter you sent to Harry). I flew up to Boston to meet with him but, he didn't consider me a good candidate. A good thing at that as the procedure caused all sorts of problems for more than a few people.

[Wise Young]

Hi, Stephen. Yes, I think I remember. That was really a long time ago.

The carecure server froze last night due to a denial of service attack last night. Sigh. I left the office at about 9 pm and it occurred just before midnight. It should be up now. Thanks.

Wise.

[Shawn]

It would be appreciated if someone could shed some light on the following:

1)Does the use of Ditropan have an effect on one's sexual function ,i.e. male - L1 incomplete para?

2)Besides Ditropan, what other med's can be used to control leakage? In other words, i'm currently using Ditropan but, it doesn't always work for me. I visit the loo almost every one and a half hour and if i'm late, it just comes out. I have no control of it and this leads me to depression, frustration and hiding from society. http://sci.rutgers.edu/forum/images/smilies/frown.gif

[Wise Young]

I have not heard or seen any report that ditropan use adversely affects erections. It is one of the most commonly used drugs in the world. If the drug had effects on erection, we would know about it. On the other hand, it may have some effects on prostate secretion and the volume of ejaculate produced by the prostate gland. There are no reports that it reduces the fertility of humans or animals at clinical doses.

Ditropan, however, has other side effects. Because it blocks acetylcholine receptors that mediate parasympathetic functions, its most common side-effect is dry mouth and associated symptoms of difficulty swallowing, sluggish pupillary response and its associated symptoms of photophobia, increased ocular tension (therefore it is contraindicated in people with glaucoma), reduced bronchial and gastrointestinal secretions (therefore, it may increase the risk of pulmonary infections and intestinal obstruction), and CNS effects including drowsiness and sleepiness.

What are some alternatives to Ditropan? As discussed in another posting named Bladder Question (http://carecure.org/forum/showthread.php?t=3197) in the Care Forum, there are numerous alternatives. One is of course intravesical instillation of ditropan which apparently is more effective than oral. Several substitutes for Ditropan have been reported to be more specific to the bladder with less dry mouth side effects. I don't have any experience with these, other than from the medical literature, and therefore hesitate to recommend them. Perhaps other people can comment.

Wise.

[SCI-Nurse]

I have had several patients report to me that their reflex erections were poorer quality or less dependable after they started Ditropan. This is not universal, but in a few select patients. Like Dr. Young, I have not seen this in the literature, but it is being occasionally reported.

Detrol is supposed to have less side effects, although this is not true for everyone. Some people find less side effects with the Ditropan XL as well. The least side effects are generally with the Ditropan instilled into the bladder rather than taken orally. (KLD)

[Shawn]

What are the effects of mixing alcohol and ditropan? http://sci.rutgers.edu/forum/images/smilies/rolleyes.gif

[Sue Pendleton]

After many all night bull sessions several friends, all female, and I came to the conclusion that ditropan does dry out other secretions too causing problems with sex for females too.