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Pharmacologic class: Anticholinergic, antimuscarinic
Therapeutic class: Renal and genitourinary agent, antispasmodic
Pregnancy risk category C
Antagonizes effects of acetylcholine on muscarinic receptors in cholinergically innervated organs, reducing bladder smooth muscle tone
Capsules (extended-release): 60 mg
Tablets: 20 mg
Indications and dosages
➣ Overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency
Adults: 20 mg P.O. twice daily 1 hour before meals or on empty stomach, or 1 60-mg capsule daily in morning with water at least 1 hour before a meal
• Severe renal impairment
• Patients age 75 and older
• Hypersensitivity to drug or its components
• Preexisting or risk of urinary or gastric retention or uncontrolled angle-closure glaucoma
Use cautiously in:
• moderate renal impairment, moderate to severe hepatic impairment, decreased GI motility, controlled angle-closure glaucoma, clinically significant bladder outflow obstruction or GI obstructive disorders
• patients at risk for heat prostration
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Give at least 1 hour before meals or on empty stomach.
CNS: headache, fatigue, syncope, hallucinations, delirium, dizziness, drowsiness
CV: tachycardia, chest pain
EENT: dry eyes, blurred vision, dry throat
GI: vomiting, constipation (new-onset or aggravated), upper abdominal pain, dyspepsia, flatulence, abdominal distention, dry mouth
GU: urinary retention
Skin: dry skin
Other: altered taste, heat prostration, angioedema
Drug-drug. Anticholinergics: additive anticholinergic effects
Digoxin, metformin, morphine, pancuronium, procainamide, tenofovir, vancomycin: increased blood levels of both drugs
Drug-behaviors. Alcohol use: increased risk of drowsiness
• Monitor renal and hepatic function tests.
• Monitor patient for decreased GI motility and urinary retention.
☞ If patient has controlled angle-closure glaucoma, stay alert for severe eye pain accompanied by nausea, rainbows around lights, red eye, and blurred vision. Be prepared to treat immediately, as appropriate.
☞ Be aware that angioedema associated with life-threatening upper airway swelling may occur. If involvement of the tongue, hypopharynx, or larynx occurs, promptly discontinue drug and provide appropriate treatment.
• Instruct patient to take tablet 1 hour before meals on an empty stomach or to take capsule in morning with water at least 1 hour before a meal.
• Instruct patient not to consume alcohol within 2 hours of taking extended-release capsule.
• Advise patient to consult prescriber before taking over-the-counter products such as antihistamines because these may increase risk of side effects.
• Inform patient that drug increases risk of heat prostration; describe symptoms and advise him to seek prompt medical attention if these occur.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• Advise patient to avoid alcohol use.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.