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Thread: Maximum oxybutynin er dose?

  1. #1
    Senior Member ~Lin's Avatar
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    Maximum oxybutynin er dose?

    I'm prescribed 10 MG oxybutynin er once a day, and have been taking it twice a day the last couple days. Ended up in the er last night after 2 days bedridden due to spasms and pain. The pain is getting better and probably caused by a traumatic catheter change, and I could deal with that alone no problem. The spasms I can't. It's gotten so bad I can't fully empty my bladder at all, and when I do partway it's still excruciating for a short while after. And I have a very strong urge feeling completely nonstop.

    The er called my urologists office and spoke with the on call Dr who was no help. Gave no suggestions the er could do for the spasms. I'm using the twice daily oxybutynin and my klonopin which is as needed for muscle spasms right now. I asked the er for more oxybutynin, hoping I'd get instant release. I didnt, I got a script of er saying take once a day so duplicate of what I already had. Can I take more than 2? I've called the on call Dr and haven't heard back yet and it's been a while. I'm supposed to be moving today and tomorrow. At the very least I need to be able to get out of bed and direct my help on what to do. Right now the spasms are horrible constantly, my only relief is dozing off, but when I wake up in joint pain needing to change position it sets them off. I'm supposed to be drinking lots of water, but I can't because the peeing is so excruciating. And not fully emptying the bladder is horrible for a uti I know, but I literally can not. I did so and it was just unbearable with me rocking nonstop for a couple hours before it let up just slightly.

    If I missed anything I also explained some here http://sci.rutgers.edu/forum/showthr...=1#post1751732
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  2. #2
    Sorry to read you're in so much pain and discomfort.
    I looked it up online it says the max dose is 30mg. No idea tough if it's ok and safe for you to increase it. Hopefully you will hear back from the on call doc soon.
    There's always something magic, there's always something true. And when you really, really need it the most, that's when rock 'n roll dreams come true. Meat Loaf

  3. #3
    I take 5mg 4 times a day which makes 20mg per day. My urologist told me to try upping the dosage to 30mg since I have been wetting between catherization. When I tried the increase it made my blood pressure sky rocket to the point it felt like my eyeballs were going to pop out of my head. I have stuck with 20mg a day for 32 years.

  4. #4
    Senior Member ~Lin's Avatar
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    Yea I thought the max was 30, but didn't know if that's with instant release or extended release. Frankly I don't know how safe 20mg with extended release is but I was so desperate, and the er didn't tell me to stop doing it.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  5. #5
    Max of short acting is 10 mg three times a day- just for SCI neurogenic bladder. Extended release - the max dose is 30 mg usually one time a day some take 15 twice a day- if it is needed and tolerate. However if you don't catheterize yourself or depend on voiding this larger amount may put you in retention= can't urinate. Of course it should wear off .The short acting you would know that it only last about 4-5 hours then is out of your system and you could void then take some more but with the extended release it just doesn't work that way. However the extended release doesn't have the "highs" that the short acting does so it might be worth trying the 30 mg and if you have the issues with retention then don't use again. However, if this is from traumatic cath-which is typically the urethral or bladder neck area- you really need to let it heal which means not urinating as each time your urinate you aggravate it. With your symptoms I would suggest an indwelling catheter )( with 20 mls of Lidocaine instilled before insertion) and keep in for a week to 10 days to let everything heal and quiet down, also check urine for infection and treat if symptoms of overactivity and spasms continue even with catheter in. Remove indwelling after this time. UTI can cause severe spasms or you might have both. I would think the MD on call could handle this situation.
    Also constipation a big issue- monitor and increase stool softeners if stool looks more firm ie. hard , like rocks etc..
    Myrbetriq is the newest med for bladder that is not an anticholinergic and does not cause the dry mouth and can actually be taken with the anticholinergics.The next step is botox to the bladder.

    CWO

  6. #6
    Senior Member ~Lin's Avatar
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    I already have an indwelling, that was the traumatic catheter change. Changing my suprapubic. I had no bladder spasms prior to the spc surgery. Since the surgery I'd been taking 10mg er until my body adjusted. Then hopefully weaning off due to gastroparesis issues, you mention constipation but hard rocks is my normal even before meds that make it worse.

    I'm in hell right now. Finally heard back from the on call Dr. Took forever for him to understand the issue is spasms. He decided to prescribe something he said would numb the inside of my bladder, it will turn my urine orange I think he said. And valium to see if it works better than the klonopin. Well they are now trying to get the valium through prior Auth and the other one will not be covered by insurance at all. On call Dr says it should only cost 15. I say I don't know where I'd get 15... When I talk to the pharmacy again, it will cost 28 for 3 pills. I don't have that at all. It's already 4pm, the guy where I'm moving to is asking when I'm going to arrive...
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  7. #7
    Senior Member ~Lin's Avatar
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    Well went back and forth with the answering company for 3 hours yesterday. Finally a new on call Dr answered. He was shocked insurance wouldn't cover the numbing medicine. He said with Medicaid it's going to take days to get the valium through. He told me to triple the dose of klonopin and take it every 8 hours. That got me through the night, probably the mixture of the klonopin sedation and having not slept the previous few nights . Sat night after the er was actually the worst spasm wise, as soon as I opened the valve to drain urine I could feel the spasms increase so stopped once I couldn't take any more. So my bladder hasn't been fully drained in days, the opposite of what you do for uti! He also recommended going back to the er and to specifically request antispasmodic meds, instead of just begging for "something for the spasms". I was loopy from the klonopin last night, but that's worn off and is not helping the spasms as much. So I'm in the er again. Hopefully they can give me something to decrease them, or the bladder numbing stuff maybe? They're so intense you can feel them with a hand on my lower abdomen or crotch.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  8. #8
    Another medication that can be used (temporarily) for severe bladder spasm is B&O (belladonna and opium) rectal suppositories. They can cause opium dependency, so should only be used for a few days, but we find they are quite helpful in managing bladder spasm (and AD due to it) post-operatively for any bladder surgical procedure. Your urologist should know about these.

    (KLD)

  9. #9
    Senior Member ~Lin's Avatar
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    I'm already opiate dependent from my chronic pain management
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  10. #10
    before my augment I was up to 50mg of oxy er.
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

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