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Maximum oxybutynin er dose?

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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:///forum/showthread.php?233127-...=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
    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

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      #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.

      Comment


        #4
        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.

        Comment


          #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
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #6
            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.

            Comment


              #7
              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.

              Comment


                #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)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  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.

                  Comment


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

                    Comment


                      #11
                      Originally posted by SCI-Nurse View Post
                      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)
                      I never spoke with my urologist, but the ones on call were absolutely awful. The first one wasn't so bad at first, and ended up deciding he would get me pyridine and valium. But the insurance wouldn't cover pyridine at all, and the valium not without a prior auth. So I spent the next 3 hours calling every 20 minutes (as the answering service would say each time "if you don't hear back in 10-15 minutes call us") for them to repeat "ok I'll try calling his cell phone again." finally 10 minutes before the pharmacy would close, a different on call Dr called me back and said it would take days to get the prior auth through (true, because I still don't have the valium). He told me I could increase the klonopin, which I immediately did after getting off the phone. And also told me if it doesn't improve (because the spasms had gotten WORSE since I'd left the ER the first time) to go back to the ER. I went back to the ER and it was a complete waste. They gave me a dose of pyridine, which since the pain had decreased would have been helpful the first time but the pain wasn't an issue this time, since the pain had been decreasing and the spasms increasing. Then they wanted to discharge me. I asked if they'd talked to the on call urologist and the nurse assured me they had. I repeated how my on call urologist told me to go to the ER and specifically ask for antispasmodics. The nurse had me sign the discharge papers, and I decided if they were really kicking me out already I'd be complaining up front... I requested to speak to the Dr. She came in and I repeated how I'd come in for the unbearable spasms and they'd done nothing for the spasms. I'd also called my Drs on call service AGAIN while waiting for the Dr, saying I wanted to know exactly what to say to the Dr or if they could possibly talk to the Dr about what to do for me. They never called back. Finally the Dr said she'd give me some valium and leaves. Later someone comes in to give me a valium, 2.5 mg pill and I ask how long its going to take to kick in, he says probably 40 minutes since its oral. He says this while I still have my IV in! then removes the IV and tells me to get dressed and leave.

                      So they didn't bother to see if it would help at all, or hell make sure I didn't have a bad reaction to it. Which was my concern since I was already on so much klonopin per the on call Dr. So I haven't slept in days now other than short dozing off from the klonopin, and still bed ridden because the spasms as so excruciating when I move. And speaking of moving, I was supposed to have been moved into my new place fully yesterday. I'm lucky they're being understanding with the medical emergency. But I have no choice, it has to be done today. when I get out of bed I feel drunk, probably from the klonopin, and I really hate that feeling. I only get the lightest sedation for things because heavy sedation makes me panic, getting drunk (has only been maybe 2-3 times in my life) made me panic. So the spasms are miserable, and then the klonopin which only takes the barest edge off ALSO makes me miserable.
                      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.

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