Oxybutynin for detrusor instability with adjuvant salivary stimulant pastilles to improve compliance: results of a multicentre, randomized controlledtrial

Objective To test the hypothesis that compliance with oxybutynin would be i mproved if the severity of dry mouth could be reduced, thus leading to impr oved urinary symptom response and improved outcome, in a randomized, contro lled trial of oxybutynin with or without salivary stimulant pastilles in pa tients with detrusor instability, Patients and methods Sixty-seven women with detrusor instability were rando mized to a variable dose regimen of oxybutynin with (37) or without (30) sa livary stimulant pastilles for 8 weeks. Patients were asked to complete a b aseline voiding diary. In weeks 1 and 2, patients were encouraged to adjust the dose of oxybutynin themselves to achieve optimum symptomatic control, A second diary was completed in the sixth week and patients were reviewed a t 8 weeks. The outcome measures were the compliance rate, followup attendan ce rate, maximum dose of medication, changes in voiding and incontinence ep isodes, and changes in severity of urgency and of dry mouth symptoms betwee n the first and sixth week, Results Of the 67 women, 32 (47%) completed the study; the proportion compl eting was the same in both groups, Four patients had slopped the medication and there was no difference in the distribution of maximum dosage achieved between the groups. Both groups reported a reduced severity of urgency sym ptoms and increased severity of dry mouth. There were no differences in rep orted symptom change between the groups during the study, Conclusions The combination of oxybutynin and salivary stimulant pastilles does not improve compliance or symptom relief compared with oxybutynin alon e: it does not allow a greater dose of oxybutynin to be tolerated.