Tolterodine tartrate

tolterodine /tol·ter·o·dine/ (tol-ter´ah-dēn) an antispasmodic used in the treatment of bladder hyperactivity.

tolterodine,

a muscarinic receptor antagonist.

indications It is used to treat overactive bladder (frequency and urgency). It controls bladder incontinence by controlling contractions.

contraindications Factors that prohibit its use include known hypersensitivity, uncontrolled narrow-angle glaucoma, urinary retention, and gastric retention.

adverse effects Adverse effects include paresthesia, fatigue, headache, chest pain, hypertension, vision abnormalities, xerophthalmia, abdominal pain, constipation, dry mouth, dyspepsia, dysuria, urinary retention, urinary frequency, urinary tract infection, rash, pruritus, bronchitis, cough, pharyngitis, and upper respiratory infection. Common side effects include anxiety, dizziness, nausea, vomiting, and anorexia.

tolterodine [tol-ter´ah-dēn]

an antispasmodic agent used in treatment of bladder hyperactivity.

tolterodine

Detrol, Detrol LA, Detrusitol (UK)

Pharmacologic class: Anticholinergic

Therapeutic class: Urinary tract antispasmodic

Pregnancy risk category C

Action

Competitively antagonizes muscarinic receptors, inhibiting bladder contractions and reducing urinary frequency

Availability

Capsules (extended-release): 2 mg, 4 mg

Tablets: 1 mg, 2 mg

⊘Indications and dosages

➣ Overactive bladder

Adults: 2 mg (immediate-release) P.O. b.i.d.; may decrease to 1 mg P.O. b.i.d. depending on response and tolerance. Or 4 mg (extended-release) P.O. daily; may decrease to 2 mg P.O. daily, depending on response.

Dosage adjustment

• Hepatic impairment or disease
• Renal impairment
• Concurrent use of potent CYP3A4 inhibitors

Contraindications

• Hypersensitivity to drug or its components
• Urinary or gastric retention
• Uncontrolled angle-closure glaucoma

Precautions

Use cautiously in
• GI obstruction, significant bladder outflow obstruction, controlled angle-closure glaucoma, significant hepatic impairment, renal impairment
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with food to increase bioavailability.

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	12 hr

Adverse reactions

CNS: headache, dizziness, vertigo, drowsiness, paresthesia, fatigue

CV: chest pain

EENT: vision abnormalities, xerophthalmia, pharyngitis

GI: diarrhea, constipation, abdominal pain, dyspepsia, dry mouth

GU: dysuria, urinary retention or frequency, urinary tract infection

Musculoskeletal: joint pain

Skin: dry skin

Other: weight gain, flulike symptoms, infection

Interactions

Drug-drug. Clarithromycin, erythromycin, itraconazole, ketoconazole, miconazole: inhibited metabolism and increased effects of tolterodine

Drug-food. Any food: increased drug bioavailability

Patient monitoring

• Monitor bladder function.
• Assess blood pressure and stay alert for chest pain.
• Monitor neurologic status. Report paresthesia or visual impairment.

Patient teaching

• Tell patient to take with food.
• If patient takes extended-release form, instruct him not to chew or crush it.
• Advise patient to use sugarless gum or hard candy to relieve dry mouth.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.