Oxybutynin with Clomipramine Interaction Details
Brand Names Associated with Oxybutynin
- Ditropan®
- Ditropan® XL
- Oxybutynin
Brand Names Associated with Clomipramine
- Anafranil®
- Clomipramine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
Decreased clomiPRAMINE efficacy
Interaction Summary
Oxybutynin was suspected of inducing the metabolism of clomiPRAMINE in an elderly female patient. Subsequent dextromethorphan testing of the patient showed that she was an extensive metabolizer (EM) of cytochrome P450 2D6 (CYP2D6). A pilot study exploring the long- and short-term effects of oxybutynin on the activity of CYP2D6 and another isoenzyme, probably of the CYP3A family, showed that oxybutynin caused a disproportionate increase of hydroxymorphinan compared with dextrorphan. Because the formation of hydroxymorphinan is mainly dependent on the activity of CYP2D6 and CYP3A4, but only the latter is known to be inducible, the authors suggest that oxybutynin is an inducer of a CYP3A subfamily.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Patients receiving concurrent therapy with clomiPRAMINE and oxybutynin should be monitored for loss of clomiPRAMINE efficacy, including worsening of symptoms. Plasma levels of clomiPRAMINE may be helpful in determining if efficacy is being compromised.
Mechanism Of Interaction
Induction by oxybutynin of cytochrome P450 3A-mediated clomiPRAMINE metabolism
Literature Reports
A) A 72-year-old female was receiving clomiPRAMINE 150 mg daily for depression with a clomiPRAMINE and desmethylclomipramine blood level of 230 ng/mL and 348 ng/mL, respectively. ClomiPRAMINE was decreased to 25 mg daily, and fluvoxamine 100 mg daily was added to therapy. Eighteen days later, her clomiPRAMINE and desmethylclomipramine levels were 405 ng/mL and 50 ng/mL, respectively. Oxybutynin 5 mg daily was initiated for urinary incontinence, and within one week the clomiPRAMINE and desmethylclomipramine levels had decreased to 133 ng/mL and less than 25 ng/mL. They remained low one week later. The patient refused to discontinue oxybutynin to determine if her clomiPRAMINE blood levels would again increase .
Oxybutynin Overview
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Oxybutynin is used to treat overactive bladder (a condition in which the bladder muscles contract uncontrollably and cause frequent urination, urgent need to urinate, and inability to control urination) in certain adults and children. Oxybutynin is also used as an extended-release tablet to control bladder muscles in adults and children 6 years of age and older with spina bifida (a disability that occurs when the spinal cord does not close properly before birth), or other nervous system conditions that affect the bladder muscles. Oxybutynin is in a class of medications called anticholinergics/antimuscarinics. It works by relaxing the bladder muscles.
Clomipramine Overview
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Clomipramine is used to treat people with obsessive-compulsive disorder (a condition that causes repeated unwanted thoughts and the need to perform certain behaviors over and over). Clomipramine is in a group of medications called tricyclic antidepressants. It works by increasing the amount of serotonin, a natural substance in the brain that is needed to maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.