Ditropan or Ditropan XL?
Posted: Sun Jun 25, 2006 1:55 pm
Is there a difference in the effectiveness of these two meds for controlling CS?
Thanks
Thanks
Hyperhidrosis Forum
Discussion forum for those suffering from hyperhidrosis and excessive sweating
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Ditropan or Ditropan XL?
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Posted: Wed Oct 25, 2006 2:49 pm
I have read that ditropan XL is less effective than regular ditropan. This is because ditropan XL has fewer side effects but u want the side effects. I have not tried it though and am really curious if it would work. So if you do try it please let me know.
Posted: Mon Nov 06, 2006 3:29 pm
Hi all
The XL variant is a 'slow-release' version of Ditropan/Oxybutynin. I have used the 'standard' version of Ditropan for quite some time now, on and off as required and as necessary with fair effect.
Being a drug where bladder-neck dysfunction is it's primary indication, there are good reasons behind using the XL version, for some individuals with this complaint.
It's use in treating Hyperhidrosis, though, is questionable - whilst it will work to an extent, what sufferers of HH need is a better assurance that the drug will support them in reducing their symptoms - the XL variant tends to not release significant enough amounts of the drug at a time, but acts over a longer time frame.
Dosage of Ditropan can be up to 20mg per day - in standard form, this equates to 4 x 5mg tablets. I know a lot of people, myself included, who have exceeded that dose by 5mgs or so per day, though not regularly, without issues at all.
It is my strong belief that the standard form is much better suited to HH treatment in most cases : it tends to act relatively fast, though it does have a fairly short half-life (the time it takes for the body to reduce the effectiveness of the active ingredient/s of the drug by half).
It should thus be taken in increments - ie, an hour or so before we will 'need' it to help us, topping-up with a little more 4-6hrs later (this being, on average, the half-life of the drug) if we still need it.
You can't get this sort of regime in using the XL, as it's designed to be released slowly and incrementally over a longer period of time : this is great for giving greater bladder-neck control, but very ordinary indeed at doing much of use for our HH.
Yes, it IS quite a personal opinion, but a well grounded one from a physiological standpoint.
So many people insist their Dr prescribes the XL (for those of us lucky enough to be able to request these things of our Doctor!) because they perceive it to be 'stronger' - which it simply, is not. We can gain a much, much greater control over our HH with careful dosage of the standard form of Ditropan according to our very individual needs.
I am happy to help anyone with this, should they need any advice, re: their own particular circumstances.
( I am now retired from the workforce following a substantial back injury in 1997, but had been a Clinical Nurse Specialist with many years practical and theoretical experience of anatomy/physiology, additional to studying toward a BSc Honours degree in Pure Human Physiology at Sheffield University, England, my old homeland, in the mid-80's.
I now reside in Australia and have done since my arrival in 1988.
I live with my wife and children, 5 in all)
The XL variant is a 'slow-release' version of Ditropan/Oxybutynin. I have used the 'standard' version of Ditropan for quite some time now, on and off as required and as necessary with fair effect.
Being a drug where bladder-neck dysfunction is it's primary indication, there are good reasons behind using the XL version, for some individuals with this complaint.
It's use in treating Hyperhidrosis, though, is questionable - whilst it will work to an extent, what sufferers of HH need is a better assurance that the drug will support them in reducing their symptoms - the XL variant tends to not release significant enough amounts of the drug at a time, but acts over a longer time frame.
Dosage of Ditropan can be up to 20mg per day - in standard form, this equates to 4 x 5mg tablets. I know a lot of people, myself included, who have exceeded that dose by 5mgs or so per day, though not regularly, without issues at all.
It is my strong belief that the standard form is much better suited to HH treatment in most cases : it tends to act relatively fast, though it does have a fairly short half-life (the time it takes for the body to reduce the effectiveness of the active ingredient/s of the drug by half).
It should thus be taken in increments - ie, an hour or so before we will 'need' it to help us, topping-up with a little more 4-6hrs later (this being, on average, the half-life of the drug) if we still need it.
You can't get this sort of regime in using the XL, as it's designed to be released slowly and incrementally over a longer period of time : this is great for giving greater bladder-neck control, but very ordinary indeed at doing much of use for our HH.
Yes, it IS quite a personal opinion, but a well grounded one from a physiological standpoint.
So many people insist their Dr prescribes the XL (for those of us lucky enough to be able to request these things of our Doctor!) because they perceive it to be 'stronger' - which it simply, is not. We can gain a much, much greater control over our HH with careful dosage of the standard form of Ditropan according to our very individual needs.
I am happy to help anyone with this, should they need any advice, re: their own particular circumstances.
( I am now retired from the workforce following a substantial back injury in 1997, but had been a Clinical Nurse Specialist with many years practical and theoretical experience of anatomy/physiology, additional to studying toward a BSc Honours degree in Pure Human Physiology at Sheffield University, England, my old homeland, in the mid-80's.
I now reside in Australia and have done since my arrival in 1988.
I live with my wife and children, 5 in all)
Posted: Mon Nov 06, 2006 8:03 pm
thankyou for replying. I thought this forum was kind of dead, so I appreciate your post. It is also nice to hear from someone taking ditropan because it is not easy to find people that do. Basically I would like to give u my story real quick...I started sweating excessively from the hands and feet in high school. This progressed and the key point I remember was after graduating high school I got really sick with mono. After that I for whatever reason had a full on sweat all over 24 hours a day. This was 2 years ago. Immediately my doctor gave me clonidine which was not great but helped somewhat. Then I took ditropan and this seemed to help the most. I would do anything to stop sweating because I was desperate and willing to take whatever. Before all this I was a very social person and loved to be the center of attention. During this I became nervous around people, and had trouble talking to people. Recently I stopped the ditropan and realized that the reason why I am so nervous around people is because my voice doesn't work. My throat is so dry from ditropan that I have to constantly strain to speak and my mouth is so dry that I can't say more than 2 words without needing a sip of water. I have read that 50% of people that take ditropan will be off it in 6 months due to the dry mouth being too severe. While I was off it the sweating of course returned and was as bad as ever so once again I am back on it. I am considering trying a drug called levsin, I know it is an anticholinergic/antispasmodic just like ditropan but I have heard the dry mouth could be less severe. I hope this doesn't mean that it will be less effective also but I am willing to try.
Have you had problems with dry mouth similar to this? And if so what have you done to cope with it? I would really appreciate any help or advice you can give me. We can probably help eachother a lot.
Have you had problems with dry mouth similar to this? And if so what have you done to cope with it? I would really appreciate any help or advice you can give me. We can probably help eachother a lot.
Posted: Tue Nov 07, 2006 2:38 am
Hi Eric
I'm really not sure about the other drug you mention, since I have no experience with it at all and am totally unfamiliar with it.
There are side-effects with Ditropan, no doubt about it - and by far, for most people anyway, the worst of these is mouth dryness.
It's always a case of compromise and I've never known it to be any other way, either for myself or anyone else I've ever encountered using not only Ditropan, but other similar agents too.
If the sweating a person has is very severe - and Ditropan does reduce it significantly, to the point where it actually restores some kind of meaningful life to the person, then I feel that these and most other side effects are worth tolerating and infinitely better than suffering a lot more with one's HH and being wet through all the time.
They don't always work as well sometimes as they do at other times - and I've found that when it REALLY gets hot, well, you could take the bottle full and get no real relief.
At best, they will help us a bit and I've found that they definitely do this for me. I do get a very dry mouth, some degree of very mild constipation, though rarely - and often, some difficulty in starting urination - all normal side-effects one would expect to see in most people.
I put up with all of them because they are less than the discomfort of not taking the drug : I will always use it selectively, ie only when I really feel that I'm going to need its help and not simply all the time, day in, day out.
There's no easy answer to this one, Eric - it's down to the individual and what they are prepared to tolerate.
As for Clonidine, they can help, but are not nearly so effective and, in my experience, have an even worse side-effect profile.
Some people with either Ditropan or Clonidine report falling asleep all the time, severe drowsiness etc etc and, quite obviously, these are major issues that warrant ceasing taking the drug.
Another thought might depend where you live : there is a drug called Robinul - and from certain places, it is available as a topical wipe : go have a look at :
www.pharmacy.ca
and look under excessive sweating. They can be ordered from anywhere in the world. The good thing with the wipes, is that they do work quite well, especially for facial sweating and, because they are topical - ie applied onto the skin surface, the amount entering the main body's system is greatly reduced compared to Ditropan etc or the oral Robinul (proper name for Robinul is Glycopyrrolate)
I know for a fact that they do work very well indeed for a lot of people and even have, somewhere if I can find it, a clinical paper on it. Again, it's a drug whose primary use wasn't meant to be HH, but a lot of it's sales go toward that very problem.
Sorry the reply isn't overly optimistic, Eric - but there are a few ways around the dry mouth thing - not perfect, but worth looking into.
Chewing gum - not always possible at work for some and not too elegant at times, but it does encourage saliva production in the mouth.
Drinking a LOT more water - and it has to be water, not other soft drink like cordials, cola etc, since these will merely dehydrate us further still.
It is imperative, in any case, to increase dramatically the amount of water we drink if taking any of these medications.
I will try and write a little more tomorrow, but have to go do a few things right now.
Cheers for the moment, Eric - but I am here to help if I'm at all able to.
***
I'm really not sure about the other drug you mention, since I have no experience with it at all and am totally unfamiliar with it.
There are side-effects with Ditropan, no doubt about it - and by far, for most people anyway, the worst of these is mouth dryness.
It's always a case of compromise and I've never known it to be any other way, either for myself or anyone else I've ever encountered using not only Ditropan, but other similar agents too.
If the sweating a person has is very severe - and Ditropan does reduce it significantly, to the point where it actually restores some kind of meaningful life to the person, then I feel that these and most other side effects are worth tolerating and infinitely better than suffering a lot more with one's HH and being wet through all the time.
They don't always work as well sometimes as they do at other times - and I've found that when it REALLY gets hot, well, you could take the bottle full and get no real relief.
At best, they will help us a bit and I've found that they definitely do this for me. I do get a very dry mouth, some degree of very mild constipation, though rarely - and often, some difficulty in starting urination - all normal side-effects one would expect to see in most people.
I put up with all of them because they are less than the discomfort of not taking the drug : I will always use it selectively, ie only when I really feel that I'm going to need its help and not simply all the time, day in, day out.
There's no easy answer to this one, Eric - it's down to the individual and what they are prepared to tolerate.
As for Clonidine, they can help, but are not nearly so effective and, in my experience, have an even worse side-effect profile.
Some people with either Ditropan or Clonidine report falling asleep all the time, severe drowsiness etc etc and, quite obviously, these are major issues that warrant ceasing taking the drug.
Another thought might depend where you live : there is a drug called Robinul - and from certain places, it is available as a topical wipe : go have a look at :
www.pharmacy.ca
and look under excessive sweating. They can be ordered from anywhere in the world. The good thing with the wipes, is that they do work quite well, especially for facial sweating and, because they are topical - ie applied onto the skin surface, the amount entering the main body's system is greatly reduced compared to Ditropan etc or the oral Robinul (proper name for Robinul is Glycopyrrolate)
I know for a fact that they do work very well indeed for a lot of people and even have, somewhere if I can find it, a clinical paper on it. Again, it's a drug whose primary use wasn't meant to be HH, but a lot of it's sales go toward that very problem.
Sorry the reply isn't overly optimistic, Eric - but there are a few ways around the dry mouth thing - not perfect, but worth looking into.
Chewing gum - not always possible at work for some and not too elegant at times, but it does encourage saliva production in the mouth.
Drinking a LOT more water - and it has to be water, not other soft drink like cordials, cola etc, since these will merely dehydrate us further still.
It is imperative, in any case, to increase dramatically the amount of water we drink if taking any of these medications.
I will try and write a little more tomorrow, but have to go do a few things right now.
Cheers for the moment, Eric - but I am here to help if I'm at all able to.
***
Posted: Tue Nov 07, 2006 10:34 pm
Thankyou for the support, that is hard to find with this condition. I understand what you mean about weighing your options and taking the lesser of two evils. I have decided that although ditropan makes it difficult for me to communicate, being soaked all hours of the day would make it impossible. I just wish that I could have my voice back and be able to speak like before. Things such as presentations and reading aloud in class have never been so hard.
I guess my best option is to continue with the ditropan and hope to find a way to better treat the dry mouth. I assume that there isn't a drug that is going to treat the sweating better (except maybe robinul) with less of a dry mouth.
You are right clonidine was awful and I would actually fall asleep with it. I think that its necessary for me to take a systemic medication although I appreciate you recommending the secure wipes. I do apply topical antiperspirant to problem areas (my back and forehead). But without medication I am in a constant cold sweat everywhere that nothing topical will prevent to a satisfactory degree.
I constantly chew gum and take sips of water but the dry mouth is still a large problem. I also take nystatin to prevent fungal infection (that I seem to keep getting because of the dry mouth).
The gum, water, and nystatin isn't cutting it so recently I bought some sugar free hard candy. This does seem to help a lot. I also bought some saliva substitute and dry mouth spray. I am curious if you have found any success with saliva substitute, hard candy, or dry mouth spray. Or if these things are just worthless. I am trying to figure out some sort of routine that allows my voice to function.
From your experience is it possible that other anticholinergic drugs could lessen the sweating without such an extreme dry mouth (I notice that ditropan is noted for excessive dry mouth even in the anticholinergic class). Or does it basically work like the worse your dry mouth the more sweating the drug will block?
Thankyou again and I hope to hear from you soon
I guess my best option is to continue with the ditropan and hope to find a way to better treat the dry mouth. I assume that there isn't a drug that is going to treat the sweating better (except maybe robinul) with less of a dry mouth.
You are right clonidine was awful and I would actually fall asleep with it. I think that its necessary for me to take a systemic medication although I appreciate you recommending the secure wipes. I do apply topical antiperspirant to problem areas (my back and forehead). But without medication I am in a constant cold sweat everywhere that nothing topical will prevent to a satisfactory degree.
I constantly chew gum and take sips of water but the dry mouth is still a large problem. I also take nystatin to prevent fungal infection (that I seem to keep getting because of the dry mouth).
The gum, water, and nystatin isn't cutting it so recently I bought some sugar free hard candy. This does seem to help a lot. I also bought some saliva substitute and dry mouth spray. I am curious if you have found any success with saliva substitute, hard candy, or dry mouth spray. Or if these things are just worthless. I am trying to figure out some sort of routine that allows my voice to function.
From your experience is it possible that other anticholinergic drugs could lessen the sweating without such an extreme dry mouth (I notice that ditropan is noted for excessive dry mouth even in the anticholinergic class). Or does it basically work like the worse your dry mouth the more sweating the drug will block?
Thankyou again and I hope to hear from you soon
Posted: Wed Nov 08, 2006 3:17 am
Hi again Eric
Promise to write more tomorrow, my friend - have read your latest and there are a few interesting points I want to raise and hopefully be a little more help to you.
Been a little busy - as an understatement!! today - we have 5 children. 3 of them still in nappies - identical twins of just over 1yr and a 2 n a half yr old boy - as well as older girls of 9 and 14, who can also be time consuming if it takes their fancy to be
will reply soon
***
Promise to write more tomorrow, my friend - have read your latest and there are a few interesting points I want to raise and hopefully be a little more help to you.
Been a little busy - as an understatement!! today - we have 5 children. 3 of them still in nappies - identical twins of just over 1yr and a 2 n a half yr old boy - as well as older girls of 9 and 14, who can also be time consuming if it takes their fancy to be
will reply soon
***
Posted: Wed Nov 08, 2006 1:59 pm
Hi again
I really do empathise with what you're experiencing with the dryness in the mouth, though in absolute fairness I don't seem to get it anywhere near so badly as you do - I have a friend who has the same issue at work, of having to do a lot of presenting and lecturing - though his issues are facial blushing and to a much lesser extent HH, therefore he doesn't really need Ditropan & similar and his speaking voice isn't an issue.
I do agree that it would be better, and certainly if the drug is working well enough for you, to try and combat the dry mouth. I'm really not so familiar with any of the saliva substitutes at all, just the ususal things like gum etc. You really do seem to have that particular side effect rather bad - could I ask what your dosage regime usually is? - ie how much at a time do you take and how soon would you take more etc etc.
I really don't think that switching to another anticholinergic will do much for you, save possibly to not work quite so well for you. It may be a much wiser thing to perhaps back-off the amount you're taking - the very reason I asked you (and by all means, tell me this privately if preferred) for how much you're taking.
There is definite value in using a combination of therapies _ ie using the wipes alongside an oral preparation - but I wouldn't bother with the wipes, especially, unless facial sweating was a substantial part of one's HH, this being where they seem to do their best work.
It's really all about titrating the dose to suit :
1. The individual
2. The nature of what he/she needs it for and when it's needed - ie work or leisure, times of day when most required.
It's very much an individual thing that needs to be messed around with a little to get optimal results for the person and, it can be played around with quite a bit, especially where how much/how often/how much total per day is concerned.
Let me know a little bit more about your regime, Eric.
The fact that you need Nystatin so frequently does indeed tell me that your side effect profile does border upon the unacceptable and we'll try and fix things up a bit, if we can
Cheers for now
***
I really do empathise with what you're experiencing with the dryness in the mouth, though in absolute fairness I don't seem to get it anywhere near so badly as you do - I have a friend who has the same issue at work, of having to do a lot of presenting and lecturing - though his issues are facial blushing and to a much lesser extent HH, therefore he doesn't really need Ditropan & similar and his speaking voice isn't an issue.
I do agree that it would be better, and certainly if the drug is working well enough for you, to try and combat the dry mouth. I'm really not so familiar with any of the saliva substitutes at all, just the ususal things like gum etc. You really do seem to have that particular side effect rather bad - could I ask what your dosage regime usually is? - ie how much at a time do you take and how soon would you take more etc etc.
I really don't think that switching to another anticholinergic will do much for you, save possibly to not work quite so well for you. It may be a much wiser thing to perhaps back-off the amount you're taking - the very reason I asked you (and by all means, tell me this privately if preferred) for how much you're taking.
There is definite value in using a combination of therapies _ ie using the wipes alongside an oral preparation - but I wouldn't bother with the wipes, especially, unless facial sweating was a substantial part of one's HH, this being where they seem to do their best work.
It's really all about titrating the dose to suit :
1. The individual
2. The nature of what he/she needs it for and when it's needed - ie work or leisure, times of day when most required.
It's very much an individual thing that needs to be messed around with a little to get optimal results for the person and, it can be played around with quite a bit, especially where how much/how often/how much total per day is concerned.
Let me know a little bit more about your regime, Eric.
The fact that you need Nystatin so frequently does indeed tell me that your side effect profile does border upon the unacceptable and we'll try and fix things up a bit, if we can
Cheers for now
***
Posted: Wed Nov 08, 2006 4:17 pm
I originally was taking 3, 5 mg pills a day. I have gone through cycles as far as when I take them. I found that taking one right before bed was a bad idea because my mouth would dry out in my sleep and I would wake up with a sore throat. I have tried a couple of regime's:
1) - take the first 5mg pill upon awaking
- take the second 5 mg pill 4 hours later
- take the 3rd 5 mg pill 4 hours after this
these times are rough and can be played with.
for example it could look like this:
take the first pill at 8am
next pill at 12pm
last pill at 4pm
If I plan on going out at night I will probably save that last pill till a little later and maybe spread the pills out more.
Because of the severe dry mouth I have stepped down to 2.5 pills a day which is 12.5 mg. rather than 15 mg.
My dosing schedule currently is something like this:
take a full 5 mg pill upon awakening (8am)
Take a half (2.5) mg pill a few hours later (12 or 1ish)
take a full 5 mg pill a few hours after that (5 or 6ish)
I have tried things such as waking up and taking 1.5 (5mg) pills to shock my body and stop the sweating then wait to take the next pill till much later.
I have also experimented taking only a half a pill at a time and taking it 5 times a day.
I would like to be able to only use ditropan when needed (ie. times of stress or when I need to be presentable) but for me ditropan doesn't seem to work that way. It takes a couple days of regular dosing for its full effect and if I miss a dose I definitely notice it.
I am of course open to suggestions and thankyou for taking the time to read this. it really does help to talk things through with someone.
1) - take the first 5mg pill upon awaking
- take the second 5 mg pill 4 hours later
- take the 3rd 5 mg pill 4 hours after this
these times are rough and can be played with.
for example it could look like this:
take the first pill at 8am
next pill at 12pm
last pill at 4pm
If I plan on going out at night I will probably save that last pill till a little later and maybe spread the pills out more.
Because of the severe dry mouth I have stepped down to 2.5 pills a day which is 12.5 mg. rather than 15 mg.
My dosing schedule currently is something like this:
take a full 5 mg pill upon awakening (8am)
Take a half (2.5) mg pill a few hours later (12 or 1ish)
take a full 5 mg pill a few hours after that (5 or 6ish)
I have tried things such as waking up and taking 1.5 (5mg) pills to shock my body and stop the sweating then wait to take the next pill till much later.
I have also experimented taking only a half a pill at a time and taking it 5 times a day.
I would like to be able to only use ditropan when needed (ie. times of stress or when I need to be presentable) but for me ditropan doesn't seem to work that way. It takes a couple days of regular dosing for its full effect and if I miss a dose I definitely notice it.
I am of course open to suggestions and thankyou for taking the time to read this. it really does help to talk things through with someone.
Posted: Wed Nov 08, 2006 9:53 pm
oh I also forgot to mention the reason why I want to try levsin is because I also suffer from Irritable bowel syndrome. I am not sure but I think that ditropan has either caused this condition for me or aggravates it. I am thinking If I can't get rid of the dry mouth atleast maybe I can get rid of the IBS.
Posted: Thu Nov 09, 2006 1:15 am
Hi Eric
I'll address the second point first - don't ask me why, though!!
All anticholinergics, as you possibly know already, will slow down the bowel's natural peristaltic motility - the end result of this, for people who do experience this as a side-effect can be a tendency toward constipation, since as the stools are moving through (especially) the large bowel, the slowing allows a lot more water to be reabsorbed by the body and thus lead to a much firmer and more constipated motion(though not everyone seems to have any side-effect issues at all with bowels/constipation etc).
I always advise everyone taking it to markedly increase their water intake and remind them that it must be water - though most people will increase their intake by virtue of mouth dryness alone, the tendency is for them to not
increase it by nearly enough. I guess a decent measure of if one is drinking enough is how ones bowels are functioning - if there's no real problem, then it's all ok-ish.
As far as IBS, physiologically speaking, it should improve it, or it's symptoms, often by quite a lot, though again, with us all being individuals, there are no hard & fast rules and anything goes at times - but it should help IBS rather than exacerbate it.
You aren't really taking massive amounts and, more importantly, appear to need the amount you're taking to do the job properly - I'm a little confused as to why you would take it before retiring to bed : though I'm more than aware of the overheating aspect overnight especially during the hotter months - but I certainly avoid it whenever I can do without it - in an ideal world the best thing, but.........
I usually take between 1 & 2 x 5mg tabs about an hour before I need them to do their stuff - with the half-life being relatively short, being for most people between 4 and 6 hours, repeating the dose will depend largely on one's needs, where one is and so on etc. So long as the amount you're taking is sufficient to give adequate relief, there's little sense in taking more before 4-5 hours have elapsed - or risk overloading the body and compounding the side-effects to the point where they are too undesirable/not tolerable.
If I've taken 2 tabs, for instance, I will follow up with a single tablet if I'm in the position where I feel I need more - ie, if I'm still out in company or doing some activity and so on. Again, the very best thing to do, is to take as little of it as you can get away with as seldom as possible - no prizes for guessing that one!! But the way to go about finding out can be a little tricky, but not impossible and well worth doing for an optimal profile for you the individual, having struck the balance between getting some relief but with the side-effects being within tolerable limits.
It's something only you can do, really Eric - try reducing the dose, slightly at first, from what you usually take and see if things remain ok at the reduced dose - then reduce it further still - and always bearing in mind to not repeat a dose before that 4-5 hours at least have elapsed.
Try and do without them altogether at night if at home - and I do know it's not the easiest thing. I'm lucky in that I have a loving and understanding wife who is incredibly supportive and understanding and I do hope your own circumstances are ok in this regard.
As far as your current regime is in geberal, you aren't doing too many things wrong, Eric - just try and extend the time slightly beyond 4hrs and have a go at titrating the dose slowly downwards until you find a happy - or happier - medium than you currently have to endure with the mouth, especially being the main nuisance for you.
You're well below the daily maximum dosage of 20mg/day, which is good - the other thing of major significance when considering the side-effects of a drug like Ditropan, is that they are the main indicator that the drug is working actively within your system. If very few or no side effects are present, it's not necessarily a good thing, since the likelihood of any relief being their for ones HH is very slim indeed. It's hard to think of them in this positive light, but it's a true fact and an indicator for proper medical management with the drug or any like it.
I realise this isn't of massive help to you and that I'm not telling you too many things you're not at least a little aware of, but it really is a juggling act with any of this stuff.
As I did mention, it's definitely worth considering combining a topical agent, say the glycopyrrolate wipes (Avert is the trade name of them) - but again, only if facial and/or palmar sweating is the main issue with ones HH. What it does mean for those individuals is that they can markedly reduce the systemic medication they are taking orally and, this, along with the fact that the topical agent is absorbed by the body minimally, will quite clearly lead to a reduction in side effects for the individual.
As for myself, I'm on a disability pension following injuring my back badly whilst working as a nurse - if I could afford to send for and use regularly,the Avert wipes, I would be using them in a flash, since my main issue by far is facial sweating - my hands and feet are as dry as a bone, luckily for me. As it stands, the Ditropan is a help, not a great one and not without issues as we've talked about, but a lot better than nothing, too.
Let me know what you think and of course, additionally about anything I might be able to help further with at all.
cheers for now
***
I'll address the second point first - don't ask me why, though!!
All anticholinergics, as you possibly know already, will slow down the bowel's natural peristaltic motility - the end result of this, for people who do experience this as a side-effect can be a tendency toward constipation, since as the stools are moving through (especially) the large bowel, the slowing allows a lot more water to be reabsorbed by the body and thus lead to a much firmer and more constipated motion(though not everyone seems to have any side-effect issues at all with bowels/constipation etc).
I always advise everyone taking it to markedly increase their water intake and remind them that it must be water - though most people will increase their intake by virtue of mouth dryness alone, the tendency is for them to not
increase it by nearly enough. I guess a decent measure of if one is drinking enough is how ones bowels are functioning - if there's no real problem, then it's all ok-ish.
As far as IBS, physiologically speaking, it should improve it, or it's symptoms, often by quite a lot, though again, with us all being individuals, there are no hard & fast rules and anything goes at times - but it should help IBS rather than exacerbate it.
You aren't really taking massive amounts and, more importantly, appear to need the amount you're taking to do the job properly - I'm a little confused as to why you would take it before retiring to bed : though I'm more than aware of the overheating aspect overnight especially during the hotter months - but I certainly avoid it whenever I can do without it - in an ideal world the best thing, but.........
I usually take between 1 & 2 x 5mg tabs about an hour before I need them to do their stuff - with the half-life being relatively short, being for most people between 4 and 6 hours, repeating the dose will depend largely on one's needs, where one is and so on etc. So long as the amount you're taking is sufficient to give adequate relief, there's little sense in taking more before 4-5 hours have elapsed - or risk overloading the body and compounding the side-effects to the point where they are too undesirable/not tolerable.
If I've taken 2 tabs, for instance, I will follow up with a single tablet if I'm in the position where I feel I need more - ie, if I'm still out in company or doing some activity and so on. Again, the very best thing to do, is to take as little of it as you can get away with as seldom as possible - no prizes for guessing that one!! But the way to go about finding out can be a little tricky, but not impossible and well worth doing for an optimal profile for you the individual, having struck the balance between getting some relief but with the side-effects being within tolerable limits.
It's something only you can do, really Eric - try reducing the dose, slightly at first, from what you usually take and see if things remain ok at the reduced dose - then reduce it further still - and always bearing in mind to not repeat a dose before that 4-5 hours at least have elapsed.
Try and do without them altogether at night if at home - and I do know it's not the easiest thing. I'm lucky in that I have a loving and understanding wife who is incredibly supportive and understanding and I do hope your own circumstances are ok in this regard.
As far as your current regime is in geberal, you aren't doing too many things wrong, Eric - just try and extend the time slightly beyond 4hrs and have a go at titrating the dose slowly downwards until you find a happy - or happier - medium than you currently have to endure with the mouth, especially being the main nuisance for you.
You're well below the daily maximum dosage of 20mg/day, which is good - the other thing of major significance when considering the side-effects of a drug like Ditropan, is that they are the main indicator that the drug is working actively within your system. If very few or no side effects are present, it's not necessarily a good thing, since the likelihood of any relief being their for ones HH is very slim indeed. It's hard to think of them in this positive light, but it's a true fact and an indicator for proper medical management with the drug or any like it.
I realise this isn't of massive help to you and that I'm not telling you too many things you're not at least a little aware of, but it really is a juggling act with any of this stuff.
As I did mention, it's definitely worth considering combining a topical agent, say the glycopyrrolate wipes (Avert is the trade name of them) - but again, only if facial and/or palmar sweating is the main issue with ones HH. What it does mean for those individuals is that they can markedly reduce the systemic medication they are taking orally and, this, along with the fact that the topical agent is absorbed by the body minimally, will quite clearly lead to a reduction in side effects for the individual.
As for myself, I'm on a disability pension following injuring my back badly whilst working as a nurse - if I could afford to send for and use regularly,the Avert wipes, I would be using them in a flash, since my main issue by far is facial sweating - my hands and feet are as dry as a bone, luckily for me. As it stands, the Ditropan is a help, not a great one and not without issues as we've talked about, but a lot better than nothing, too.
Let me know what you think and of course, additionally about anything I might be able to help further with at all.
cheers for now
***
Posted: Thu Nov 09, 2006 11:17 pm
I think you are right, I probably do need to spread it out more. I am going to experiment with this and I will keep you updated with my progress. I would take a pill and then sometimes just a couple hours later take more.
The most I have ever taken at once is 1.5x5mg. I noticed that you said you have taken 2 tabs at once. If I am just taking ditropan before events then 1 tab probably won't stop my sweating but I guess I should try 2 and see what happens, then not take anymore for the rest of the day. Basically because the half life is 4-5 hours it is in my best interest to take a larger dose and wait the 4-5 hours to take more, rather than taking it more frequently? That is good to know and will be helpful.
Ditropan says diarrhea as well as constipation are side effects, while levsin just says constipation. My IBS is actually more related to diarrhea and stomach pains. I take a fiber drink once a day and try to use immodium/tums/pepto bismol when necessary. I have heard that ditropan is supposed to make food go through you slowly but for whatever reason it seems to make things go right through me.
The most I have ever taken at once is 1.5x5mg. I noticed that you said you have taken 2 tabs at once. If I am just taking ditropan before events then 1 tab probably won't stop my sweating but I guess I should try 2 and see what happens, then not take anymore for the rest of the day. Basically because the half life is 4-5 hours it is in my best interest to take a larger dose and wait the 4-5 hours to take more, rather than taking it more frequently? That is good to know and will be helpful.
Ditropan says diarrhea as well as constipation are side effects, while levsin just says constipation. My IBS is actually more related to diarrhea and stomach pains. I take a fiber drink once a day and try to use immodium/tums/pepto bismol when necessary. I have heard that ditropan is supposed to make food go through you slowly but for whatever reason it seems to make things go right through me.
Posted: Fri Nov 10, 2006 2:59 pm
Hi Eric
With Ditropan, the temdency will most certainly be towards constipation : with any pharmaceuticals, you can find that they will state a lot of side-effects as being possible, basically because they are obliged to do so by law.
When they trial drugs, people trialling the drug report all symptoms, many of which are in fact unrelated to the drug at all, but coincidentally the person is experiencing whilst trialling the drug. If enough, and enough might represent a relatively small proportion of the number of people trialled, then they have to put it as a possible side-effect in their prescribing literature. I know all of this having worked within the pharmaceutical industry as a Medical Representative - it's just something they are obliged to do if enough of the 'trialled' people report symptoms, even if the number might only represent a few percent of the overall number in the trial. Nausea & Vomiting is one you'll see on almost all medications - and under the 'special precautions' listing in the prescribing information for any drug, you'll find 'use with caution with any liver damage or dysfunction' - which is the 'big' one - since it's the one that avoids huge lawsuits - all drugs, well almost all drugs, have to make a pass through the liver - its a good and a bad thing, since the liver detoxifies any 'poisons' we ingest - the bad side, in so far as drug manufacturers are concerned, is that this 'pass' through the liver renders a lot of the active ingredient in the drug useless. Anyone with liver impairment that is severe enough will allow more drug to get through to the rest of the body - and in certain cases, the amount it lets through can be lethal or damaging at least - apologies for the ramble-on there - I don't know what came over me!!
As an anticholinergic, physiologically, Ditropan will most definitely reduce the bowel's natural peristaltic rhythmic movement more make the bowel generally significantly more sluggish - and should thus be helpful with IBS rather than aggravate it. It happens to a lesser or greater extent between individuals - I would have imagined for yourself, for example, that since you have severe side-effects with dry mouth, that you would also have very significant ones with the gut as well - but again, there are so many variables with this - things don't always behave as we expect them to. Some people report a degree of bloating of the abdomen - I myself do get just a little of this, which is entirely related to the aforementioned slowing down of the gut in general.
Now then.....what to do......
I would really not advise that you take more at a time, Eric - but that if at all possible, to actually take less at a time. The dry mouth you are experiencing, which is very significant indeed for you, is an indication that the drug is very active within you - it will never stop all sweating - well, that's not strictly speaking true, as it can do if enough is taken but to the detriment of the individual - we do need to sweat, even if just a little and not doing so at all is a very harmful thing - but I digress.
Taking more at a time, for you, will merely worsen the dry mouth - and lets remember it's already unbearable and requires that you need Nystatin - in other words, you are highly unlikely to reduce your 'sweating' further, or if so by a very small amount - but your side effects will worsen, something I really don't feel you could tolerate and, more importantly, it wouldn't be the right treatment regime for you.
With me, I am able, at times, to take a large-ish dose because it doesn't cause me anything like the grief it causes you, Eric - purely due to us having different anatomical & physiological qualities to one another.
Here's what to do:
Begin by slightly reducing the amount you normally take : if you normally take one tablet, try taking 3/4 of a tablet and if that still works as well, pretty much, as a whole tablet, so much the better.
Then try reducing it to a half tablet - in other words, find a dosage regimen that suits you, with the balance of relieving some of your HH symptoms but not causing you so many side effects as to render it troublesome to bother going through it all the time.
There will come a point where the efficacy will reduce below that which you are gaining any benefit from, but you will almost certainly find that by reducing the dose, even by a small amount, 'should' reduce the side-effects, most notably, the mouth dryness.
It's a difficult concept to get your head around sometimes, I do realise - it's the side-effects that tell a physician/clinician that a drug is doing what it's designed to do, not simply how well it's treating the thing it's been prescribed for. For you to increase the dose would not be the way to go - it's hard to imagine that the drug could become more 'active' within your body, Eric - it's causing you to need Nystan, and that's a severely dry mouth. It may be, as it is the case with most people, that the best you can hope for with an anticholinergic of any kind is partial relief from the sweating. A lot of people write to me and say that they are still sweating, it hasn't worked etc etc - their symptoms have reduced markedly but their expectations of the drug, was that it would take away ALL issues of sweating - which it just isn't designed to do and, in fact, is a very dangerous goal to aim for, especially in some climates and some occupations, lifestyles etc.
Also, as you mention, don't take more until at least 4-5 hours have elapsed - this is very important if what we're aiming for is the same or very close to the same HH relief but a much improved side-effect profile for you. Something else to note, though I'm sure you're a little aware of anyway, is to take it around one hour or so before you'll 'need' it.
I would strongly advise to reduce it - ie each dose you take - by just a quarter of a tablet per dosage, to begin with - and maintain this for a week at least, noting down what has happened, is the sweating relief less or around the same, any improvements in the mouth etc etc - and of course, keep me posted
I wish you well with it all, Eric - and feel sure that there is at least some improvement ahead for the mouth dryness, however slight, without it compromising the HH relief significantly.
Cheers for now - let me know anytime if you need more help/advice with this or anything else - I'm glad to be able to help
***
With Ditropan, the temdency will most certainly be towards constipation : with any pharmaceuticals, you can find that they will state a lot of side-effects as being possible, basically because they are obliged to do so by law.
When they trial drugs, people trialling the drug report all symptoms, many of which are in fact unrelated to the drug at all, but coincidentally the person is experiencing whilst trialling the drug. If enough, and enough might represent a relatively small proportion of the number of people trialled, then they have to put it as a possible side-effect in their prescribing literature. I know all of this having worked within the pharmaceutical industry as a Medical Representative - it's just something they are obliged to do if enough of the 'trialled' people report symptoms, even if the number might only represent a few percent of the overall number in the trial. Nausea & Vomiting is one you'll see on almost all medications - and under the 'special precautions' listing in the prescribing information for any drug, you'll find 'use with caution with any liver damage or dysfunction' - which is the 'big' one - since it's the one that avoids huge lawsuits - all drugs, well almost all drugs, have to make a pass through the liver - its a good and a bad thing, since the liver detoxifies any 'poisons' we ingest - the bad side, in so far as drug manufacturers are concerned, is that this 'pass' through the liver renders a lot of the active ingredient in the drug useless. Anyone with liver impairment that is severe enough will allow more drug to get through to the rest of the body - and in certain cases, the amount it lets through can be lethal or damaging at least - apologies for the ramble-on there - I don't know what came over me!!
As an anticholinergic, physiologically, Ditropan will most definitely reduce the bowel's natural peristaltic rhythmic movement more make the bowel generally significantly more sluggish - and should thus be helpful with IBS rather than aggravate it. It happens to a lesser or greater extent between individuals - I would have imagined for yourself, for example, that since you have severe side-effects with dry mouth, that you would also have very significant ones with the gut as well - but again, there are so many variables with this - things don't always behave as we expect them to. Some people report a degree of bloating of the abdomen - I myself do get just a little of this, which is entirely related to the aforementioned slowing down of the gut in general.
Now then.....what to do......
I would really not advise that you take more at a time, Eric - but that if at all possible, to actually take less at a time. The dry mouth you are experiencing, which is very significant indeed for you, is an indication that the drug is very active within you - it will never stop all sweating - well, that's not strictly speaking true, as it can do if enough is taken but to the detriment of the individual - we do need to sweat, even if just a little and not doing so at all is a very harmful thing - but I digress.
Taking more at a time, for you, will merely worsen the dry mouth - and lets remember it's already unbearable and requires that you need Nystatin - in other words, you are highly unlikely to reduce your 'sweating' further, or if so by a very small amount - but your side effects will worsen, something I really don't feel you could tolerate and, more importantly, it wouldn't be the right treatment regime for you.
With me, I am able, at times, to take a large-ish dose because it doesn't cause me anything like the grief it causes you, Eric - purely due to us having different anatomical & physiological qualities to one another.
Here's what to do:
Begin by slightly reducing the amount you normally take : if you normally take one tablet, try taking 3/4 of a tablet and if that still works as well, pretty much, as a whole tablet, so much the better.
Then try reducing it to a half tablet - in other words, find a dosage regimen that suits you, with the balance of relieving some of your HH symptoms but not causing you so many side effects as to render it troublesome to bother going through it all the time.
There will come a point where the efficacy will reduce below that which you are gaining any benefit from, but you will almost certainly find that by reducing the dose, even by a small amount, 'should' reduce the side-effects, most notably, the mouth dryness.
It's a difficult concept to get your head around sometimes, I do realise - it's the side-effects that tell a physician/clinician that a drug is doing what it's designed to do, not simply how well it's treating the thing it's been prescribed for. For you to increase the dose would not be the way to go - it's hard to imagine that the drug could become more 'active' within your body, Eric - it's causing you to need Nystan, and that's a severely dry mouth. It may be, as it is the case with most people, that the best you can hope for with an anticholinergic of any kind is partial relief from the sweating. A lot of people write to me and say that they are still sweating, it hasn't worked etc etc - their symptoms have reduced markedly but their expectations of the drug, was that it would take away ALL issues of sweating - which it just isn't designed to do and, in fact, is a very dangerous goal to aim for, especially in some climates and some occupations, lifestyles etc.
Also, as you mention, don't take more until at least 4-5 hours have elapsed - this is very important if what we're aiming for is the same or very close to the same HH relief but a much improved side-effect profile for you. Something else to note, though I'm sure you're a little aware of anyway, is to take it around one hour or so before you'll 'need' it.
I would strongly advise to reduce it - ie each dose you take - by just a quarter of a tablet per dosage, to begin with - and maintain this for a week at least, noting down what has happened, is the sweating relief less or around the same, any improvements in the mouth etc etc - and of course, keep me posted
I wish you well with it all, Eric - and feel sure that there is at least some improvement ahead for the mouth dryness, however slight, without it compromising the HH relief significantly.
Cheers for now - let me know anytime if you need more help/advice with this or anything else - I'm glad to be able to help
***
Posted: Fri Nov 10, 2006 3:39 pm
ok I understand now. Thankyou for clearing that up. I will take .75 3 times a day, 1 hour before I am going to need it. I hope this works and I will of course let u know how it is going. Thankyou!
Posted: Fri Nov 10, 2006 3:47 pm
No probs at all, Eric - I've edited my post a little, mainly going-off on a bit of a rant, but it might warrant a revisit for informations sake.
Cheers
***
Cheers
***